Ultrasonic surgical instruments with distally positioned jaw assemblies

ABSTRACT

Various embodiments are directed to surgical instruments comprising an end effector, a shaft and a jaw assembly. The end effector may comprise an ultrasonic blade extending distally substantially parallel to a longitudinal axis. The shaft may extend proximally from the end effector along the longitudinal axis. The jaw assembly may comprise first and second jaw members. The jaw assembly may be pivotable about a first axis substantially perpendicular to the longitudinal axis from a first position where the first and second jaw members are substantially parallel to the ultrasonic blade to a second position. Additionally, the first and second jaw members may be pivotable about a second axis substantially perpendicular to the first axis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application claiming priority under 35U.S.C. § 121 to U.S. patent application Ser. No. 15/167,193, entitledULTRASONIC SURGICAL INSTRUMENTS WITH DISTALLY POSITIONED JAW ASSEMBLIES,filed May 27, 2016, which issued on Jan. 28, 2020 as U.S. Pat. No.10,543,008, which is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 13/538,711, entitledULTRASONIC SURGICAL INSTRUMENTS WITH DISTALLY POSITIONED JAW ASSEMBLIES,filed Jun. 29, 2012, which issued on May 31, 2015 as U.S. Pat. No.9,351,754, the entire disclosures of which are hereby incorporated byreference herein.

The subject application is related to the following commonly-ownedapplications filed on Jun. 29, 2012, the disclosure of each is herebyincorporated by reference in their entirety:

U.S. application Ser. No. 13/539,096, entitled HAPTIC FEEDBACK DEVICESFOR SURGICAL ROBOT, now U.S. Pat. No. 9,351,754;

U.S. application Ser. No. 13/539,110, entitled LOCKOUT MECHANISM FOR USEWITH ROBOTIC ELECTROSURGICAL DEVICE, now U.S. Pat. No. 9,326,788;

U.S. application Ser. No. 13/539,117, entitled CLOSED FEEDBACK CONTROLFOR ELECTROSURGICAL DEVICE, now U.S. Pat. No. 9,226,767;

U.S. application Ser. No. 13/538,588, entitled SURGICAL INSTRUMENTS WITHARTICULATING SHAFTS, now U.S. Pat. No. 9,393,037;

U.S. application Ser. No. 13/538,601, entitled ULTRASONIC SURGICALINSTRUMENTS WITH DISTALLY POSITIONED TRANSDUCERS, now U.S. PatentApplication Publication No. 2014/0005702;

U.S. application Ser. No. 13/538,700, entitled SURGICAL INSTRUMENTS WITHARTICULATING SHAFTS, now U.S. Pat. No. 9,408,622;

U.S. application Ser. No. 13/538,720, entitled SURGICAL INSTRUMENTS WITHARTICULATING SHAFTS, now U.S. Patent Application Publication No.2014/0005705;

U.S. application Ser. No. 13/538,733, entitled ULTRASONIC SURGICALINSTRUMENTS WITH CONTROL MECHANISMS, now U.S. Pat. No. 9,820,768; and

U.S. application Ser. No. 13/539,122, entitled “Surgical InstrumentsWith Fluid Management System” now U.S. Patent Application PublicationNo. 2014/0005668.

BACKGROUND

Various embodiments are directed to surgical instruments includingultrasonic instruments distally positioned jaw assemblies.

Ultrasonic surgical devices, such as ultrasonic scalpels, are used inmany applications in surgical procedures by virtue of their uniqueperformance characteristics. Depending upon specific deviceconfigurations and operational parameters, ultrasonic surgical devicescan provide substantially simultaneous transection of tissue andhomeostasis by coagulation, desirably minimizing patient trauma. Anultrasonic surgical device comprises a proximally-positioned ultrasonictransducer and an instrument coupled to the ultrasonic transducer havinga distally-mounted end effector comprising an ultrasonic blade to cutand seal tissue. The end effector is typically coupled either to ahandle and/or a robotic surgical implement via a shaft. The blade isacoustically coupled to the transducer via a waveguide extending throughthe shaft. Ultrasonic surgical devices of this nature can be configuredfor open surgical use, laparoscopic, or endoscopic surgical proceduresincluding robotic-assisted procedures.

Ultrasonic energy cuts and coagulates tissue using temperatures lowerthan those used in electrosurgical procedures. Vibrating at highfrequencies (e.g., 55,500 times per second), the ultrasonic bladedenatures protein in the tissue to form a sticky coagulum. Pressureexerted on tissue by the blade surface collapses blood vessels andallows the coagulum to form a hemostatic seal. A surgeon can control thecutting speed and coagulation by the force applied to the tissue by theend effector, the time over which the force is applied and the selectedexcursion level of the end effector.

It is often desirable for clinicians to articulate a distal portion ofthe instrument shaft in order to direct the application of ultrasonicand/or RF energy. Such articulation is challenging and often limited inembodiments where an ultrasonic waveguide extends from aproximally-positioned transducer to the distally-positioned ultrasonicblade.

DRAWINGS

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 illustrates one embodiment of a surgical system including asurgical instrument and an ultrasonic generator.

FIG. 2 illustrates one embodiment of the surgical instrument shown inFIG. 1.

FIG. 3 illustrates one embodiment of an ultrasonic end effector.

FIG. 4 illustrates another embodiment of an ultrasonic end effector.

FIG. 5 illustrates an exploded view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 6 illustrates a cut-away view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 7 illustrates various internal components of one embodiment of thesurgical instrument shown in FIG. 1

FIG. 8 illustrates a top view of one embodiment of a surgical systemincluding a surgical instrument and an ultrasonic generator.

FIG. 9 illustrates one embodiment of a rotation assembly included in oneexample embodiment of the surgical instrument of FIG. 1.

FIG. 10 illustrates one embodiment of a surgical system including asurgical instrument having a single element end effector.

FIG. 11 illustrates a block diagram of one embodiment of a roboticsurgical system.

FIG. 12 illustrates one embodiment of a robotic arm cart.

FIG. 13 illustrates one embodiment of the robotic manipulator of therobotic arm cart of FIG. 12.

FIG. 14 illustrates one embodiment of a robotic arm cart having analternative set-up joint structure.

FIG. 15 illustrates one embodiment of a controller that may be used inconjunction with a robotic arm cart, such as the robotic arm carts ofFIGS. 11-14.

FIG. 16 illustrates one embodiment of an ultrasonic surgical instrumentadapted for use with a robotic system.

FIG. 25 illustrates one embodiment of an electrosurgical instrumentadapted for use with a robotic system.

FIG. 17 illustrates one embodiment of an instrument drive assembly thatmay be coupled to a surgical manipulators to receive and control thesurgical instrument shown in FIG. 16.

FIG. 18 illustrates another view of the instrument drive assemblyembodiment of FIG. 26 including the surgical instrument of FIG. 16.

FIGS. 19-21 illustrate additional views of the adapter portion of theinstrument drive assembly embodiment of FIG. 26.

FIGS. 22-24 illustrate one embodiment of the instrument mounting portionof FIG. 16 showing components for translating motion of the drivenelements into motion of the surgical instrument.

FIGS. 25-27 illustrate an alternate embodiment of the instrumentmounting portion of FIG. 16 showing an alternate example mechanism fortranslating rotation of the driven elements into rotational motion aboutthe axis of the shaft and an alternate example mechanism for generatingreciprocating translation of one or more members along the axis of theshaft.

FIGS. 28-32 illustrate an alternate embodiment of the instrumentmounting portion FIG. 16 showing another alternate example mechanism fortranslating rotation of the driven elements into rotational motion aboutthe axis of the shaft.

FIGS. 33-36A illustrate an alternate embodiment of the instrumentmounting portion showing an alternate example mechanism for differentialtranslation of members along the axis of the shaft (e.g., forarticulation).

FIGS. 36B-36C illustrate one embodiment of a tool mounting portioncomprising internal power and energy sources.

FIGS. 37-38 illustrates one embodiment of a distal portion of a surgicalinstrument comprising a distally positioned jaw assembly.

FIG. 39 illustrates a head-on view of one embodiment of the distalportion of the surgical instrument of FIGS. 37-38.

FIGS. 40-41 illustrate one embodiment of the distal portion of thesurgical instrument of FIGS. 37-38 coupled to an instrument mountingportion for use with a robotic surgical system.

FIGS. 42-44 illustrate one embodiment of the distal portion of thesurgical instrument of FIGS. 37-38 showing additional controlmechanisms.

FIG. 45A illustrates one embodiment of the instrument mounting portionshowing an example mechanism for actuating various control lines of thesurgical instrument of FIGS. 37-38.

FIG. 45B illustrates a side view of one embodiment of the routers.

FIGS. 46-47 illustrate one embodiment of the distal portion of thesurgical instrument of FIGS. 37-38 with a retractable ultrasonic blade.

FIG. 48 illustrates one embodiment of the distal portion of the surgicalinstrument of FIGS. 37-38 coupled to an instrument mounting portion of arobotic surgical system configured to extend and retract the ultrasonicblade.

FIG. 49 illustrates an alternate embodiment of the distal portion of thesurgical instrument of FIGS. 37-38 coupled to an instrument mountingportion of a robotic surgical system with an external transducer.

FIG. 50 illustrates an additional view of the distal portion of thesurgical instrument of FIGS. 37-38 as illustrated in FIG. 49.

FIG. 51 illustrates one embodiment of the jaw assembly comprising aclamp pad.

FIGS. 52-56 illustrate one embodiment of a distal portion of a surgicalinstrument comprising a jaw assembly with a U-shaped jaw member.

DESCRIPTION

Various embodiments described herein are directed to surgicalinstruments comprising distally positioned, articulatable jawassemblies. The jaw assemblies may be utilized in lieu of or in additionto shaft articulation. For example, the jaw assemblies may be utilizedto grasp tissue and move it towards an ultrasonic blade, RF electrodesor other component for treating tissue.

According to one example embodiments, a surgical instrument may comprisean end effector with an ultrasonic blade extending distally therefrom.The jaw assembly may be articulatable and may pivot about at least twoaxes. A first axis, or wrist pivot axis, may be substantiallyperpendicular to a longitudinal axis of the instrument shaft. The jawassembly may pivot about the wrist pivot axis from a first positionwhere the jaw assembly is substantially parallel to the ultrasonic bladeto a second position where the jaw assembly is not substantiallyparallel to the ultrasonic blade. In addition, the jaw assembly maycomprise first and second jaw members that are pivotable about a secondaxis or jaw pivot axis. The jaw pivot axis may be substantiallyperpendicular to the wrist pivot axis. In some embodiments, the jawpivot axis itself may pivot as the jaw assembly pivots about the wristpivot axis. The first and second jaw members may be pivotably relativeto one another about the jaw pivot axis such that the first and secondjaw members may “open” and “close.” Additionally, in some embodiments,the first and second jaw members are also pivotable about the jaw pivotaxis together such that the direction of the first and second jawmembers may change.

In various embodiments, the jaw assembly is controlled by a series oflines and/or cables that extend proximally from the jaw assembly to amanual handle and/or instrument mounting portion of a robotic surgicalsystem. First and second lines may control pivoting of the jaw assemblyabout the wrist pivot axis. A first line may be coupled to the jawassembly at a position offset from the wrist pivot axis. A second linemay be coupled to the jaw assembly at a second position offset from thewrist pivot axis and substantially opposite the first position.Differential translation of the first and second lines may causepivoting of the jaw assembly about the wrist pivot axis. For example,proximal translation of one of the lines may cause the jaw assembly topivot away from the longitudinal axis of the shaft towards theproximally translated line. In some embodiments, the jaw assembly maycomprise a pulley positioned about the wrist pivot axis. The first andsecond lines may be first and second ends of a single line wrappedaround the pulley.

The first and second jaw members may be similarly controlled. Forexample, in some embodiments, each jaw member is coupled to two controllines that extend proximally from the jaw assembly through the shaft tothe manual handle and/or instrument mounting portion of the roboticsurgical system. The control lines for each jaw member may be offsetfrom one another about the jaw pivot axis such that proximal translationof one control line pivots the jaw about the jaw pivot axis in a firstdirection and proximal translation of the other control line pivots thejaw about the jaw pivot axis in a second direction opposite the first.In some embodiments the first and second jaw members comprise pulleyspositioned about the jaw pivot axis and the first and second controllines for each jaw member are ends of a single control line wrappedaround the respective pulleys. In some embodiments, the jaw members areseparately controllable. For example, the jaw members may open and closeabout the jaw pivot axis and may additional pivot together about the jawpivot axis.

Reference will now be made in detail to several embodiments, includingembodiments showing example implementations of manual and roboticsurgical instruments with end effectors comprising ultrasonic and/orelectrosurgical elements. Wherever practicable similar or like referencenumbers may be used in the figures and may indicate similar or likefunctionality. The figures depict example embodiments of the disclosedsurgical instruments and/or methods of use for purposes of illustrationonly. One skilled in the art will readily recognize from the followingdescription that alternative example embodiments of the structures andmethods illustrated herein may be employed without departing from theprinciples described herein.

FIG. 1 is a right side view of one embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, the ultrasonic surgicalinstrument 10 may be employed in various surgical procedures includingendoscopic or traditional open surgical procedures. In one exampleembodiment, the ultrasonic surgical instrument 10 comprises a handleassembly 12, an elongated shaft assembly 14, and an ultrasonictransducer 16. The handle assembly 12 comprises a trigger assembly 24, adistal rotation assembly 13, and a switch assembly 28. The elongatedshaft assembly 14 comprises an end effector assembly 26, which compriseselements to dissect tissue or mutually grasp, cut, and coagulate vesselsand/or tissue, and actuating elements to actuate the end effectorassembly 26. The handle assembly 12 is adapted to receive the ultrasonictransducer 16 at the proximal end. The ultrasonic transducer 16 ismechanically engaged to the elongated shaft assembly 14 and portions ofthe end effector assembly 26. The ultrasonic transducer 16 iselectrically coupled to a generator 20 via a cable 22. Although themajority of the drawings depict a multiple end effector assembly 26 foruse in connection with laparoscopic surgical procedures, the ultrasonicsurgical instrument 10 may be employed in more traditional open surgicalprocedures and in other embodiments, may be configured for use inendoscopic procedures. For the purposes herein, the ultrasonic surgicalinstrument 10 is described in terms of an endoscopic instrument;however, it is contemplated that an open and/or laparoscopic version ofthe ultrasonic surgical instrument 10 also may include the same orsimilar operating components and features as described herein.

In various embodiments, the generator 20 comprises several functionalelements, such as modules and/or blocks. Different functional elementsor modules may be configured for driving different kinds of surgicaldevices. For example, an ultrasonic generator module 21 may drive anultrasonic device, such as the ultrasonic surgical instrument 10. Insome example embodiments, the generator 20 also comprises anelectrosurgery/RF generator module 23 for driving an electrosurgicaldevice (or an electrosurgical embodiment of the ultrasonic surgicalinstrument 10). In the example embodiment illustrated in FIG. 1, thegenerator 20 includes a control system 25 integral with the generator20, and a foot switch 29 connected to the generator via a cable 27. Thegenerator 20 may also comprise a triggering mechanism for activating asurgical instrument, such as the instrument 10. The triggering mechanismmay include a power switch (not shown) as well as a foot switch 29. Whenactivated by the foot switch 29, the generator 20 may provide energy todrive the acoustic assembly of the surgical instrument 10 and to drivethe end effector 18 at a predetermined excursion level. The generator 20drives or excites the acoustic assembly at any suitable resonantfrequency of the acoustic assembly and/or derives thetherapeutic/sub-therapeutic electromagnetic/RF energy. As shown in FIG.1, according to various embodiments, the ultrasonic generator module 21and/or the electrosurgery/RF generator module 23 may be located externalto the generator (shown in phantom as ultrasonic generator module 21′and electrosurgery/RF generator module 23′).

In one embodiment, the electrosurgical/RF generator module 23 may beimplemented as an electrosurgery unit (ESU) capable of supplying powersufficient to perform bipolar electrosurgery using radio frequency (RF)energy. In one embodiment, the ESU can be a bipolar ERBE ICC 350 sold byERBE USA, Inc. of Marietta, Ga. In bipolar electrosurgery applications,as previously discussed, a surgical instrument having an activeelectrode and a return electrode can be utilized, wherein the activeelectrode and the return electrode can be positioned against, oradjacent to, the tissue to be treated such that current can flow fromthe active electrode to the return electrode through the tissue.Accordingly, the electrosurgical/RF module 23 generator may beconfigured for therapeutic purposes by applying electrical energy to thetissue T sufficient for treating the tissue (e.g., cauterization). Forexample, in some embodiments, the active and/or return electrode may bepositioned on the jaw assembly described herein.

In one embodiment, the electrosurgical/RF generator module 23 may beconfigured to deliver a subtherapeutic RF signal to implement a tissueimpedance measurement module. In one embodiment, the electrosurgical/RFgenerator module 23 comprises a bipolar radio frequency generator asdescribed in more detail below. In one embodiment, theelectrosurgical/RF generator module 23 may be configured to monitorelectrical impedance Z, of tissue T and to control the characteristicsof time and power level based on the tissue T by way of a returnelectrode provided on a clamp member of the end effector assembly 26.Accordingly, the electrosurgical/RF generator module 23 may beconfigured for subtherapeutic purposes for measuring the impedance orother electrical characteristics of the tissue T. Techniques and circuitconfigurations for measuring the impedance or other electricalcharacteristics of tissue T are discussed in more detail in commonlyassigned U.S. Patent Publication No. 2011/0015631, titled“Electrosurgical Generator for Ultrasonic Surgical Instrument,” thedisclosure of which is herein incorporated by reference in its entirety.

A suitable ultrasonic generator module 21 may be configured tofunctionally operate in a manner similar to the GEN300 sold by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio as is disclosed in one or more ofthe following U.S. patents, all of which are incorporated by referenceherein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of anUltrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291(Method for Detecting Blade Breakage Using Rate and/or ImpedanceInformation); U.S. Pat. No. 6,662,127 (Method for Detecting Presence ofa Blade in an Ultrasonic System); U.S. Pat. No. 6,977,495 (DetectionCircuitry for Surgical Handpiece System); U.S. Pat. No. 7,077,853(Method for Calculating Transducer Capacitance to Determine TransducerTemperature); U.S. Pat. No. 7,179,271 (Method for Driving an UltrasonicSystem to Improve Acquisition of Blade Resonance Frequency at Startup);and U.S. Pat. No. 7,273,483 (Apparatus and Method for Alerting GeneratorFunction in an Ultrasonic Surgical System).

It will be appreciated that in various embodiments, the generator 20 maybe configured to operate in several modes. In one mode, the generator 20may be configured such that the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be operated independently.

For example, the ultrasonic generator module 21 may be activated toapply ultrasonic energy to the end effector assembly 26 andsubsequently, either therapeutic or sub-therapeutic RF energy may beapplied to the end effector assembly 26 by the electrosurgical/RFgenerator module 23. As previously discussed, the sub-therapeuticelectrosurgical/RF energy may be applied to tissue clamped between claimelements of the end effector assembly 26 to measure tissue impedance tocontrol the activation, or modify the activation, of the ultrasonicgenerator module 21. Tissue impedance feedback from the application ofthe sub-therapeutic energy also may be employed to activate atherapeutic level of the electrosurgical/RF generator module 23 to sealthe tissue (e.g., vessel) clamped between claim elements of the endeffector assembly 26.

In another embodiment, the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be activated simultaneously.In one example, the ultrasonic generator module 21 is simultaneouslyactivated with a sub-therapeutic RF energy level to measure tissueimpedance simultaneously while the ultrasonic blade of the end effectorassembly 26 cuts and coagulates the tissue (or vessel) clamped betweenthe clamp elements of the end effector assembly 26. Such feedback may beemployed, for example, to modify the drive output of the ultrasonicgenerator module 21. In another example, the ultrasonic generator module21 may be driven simultaneously with electrosurgical/RF generator module23 such that the ultrasonic blade portion of the end effector assembly26 is employed for cutting the damaged tissue while theelectrosurgical/RF energy is applied to electrode portions of the endeffector clamp assembly 26 for sealing the tissue (or vessel).

When the generator 20 is activated via the triggering mechanism,electrical energy is continuously applied by the generator 20 to atransducer stack or assembly of the acoustic assembly. In anotherembodiment, electrical energy is intermittently applied (e.g., pulsed)by the generator 20. A phase-locked loop in the control system of thegenerator 20 may monitor feedback from the acoustic assembly. The phaselock loop adjusts the frequency of the electrical energy sent by thegenerator 20 to match the resonant frequency of the selectedlongitudinal mode of vibration of the acoustic assembly. In addition, asecond feedback loop in the control system 25 maintains the electricalcurrent supplied to the acoustic assembly at a pre-selected constantlevel in order to achieve substantially constant excursion at the endeffector 18 of the acoustic assembly. In yet another embodiment, a thirdfeedback loop in the control system 25 monitors impedance betweenelectrodes located in the end effector assembly 26. Although FIGS. 1-9show a manually operated ultrasonic surgical instrument, it will beappreciated that ultrasonic surgical instruments may also be used inrobotic applications, for example, as described herein as well ascombinations of manual and robotic applications.

In ultrasonic operation mode, the electrical signal supplied to theacoustic assembly may cause the distal end of the end effector 18, tovibrate longitudinally in the range of, for example, approximately 20kHz to 250 kHz. According to various embodiments, the blade 22 mayvibrate in the range of about 54 kHz to 56 kHz, for example, at about55.5 kHz. In other embodiments, the blade 22 may vibrate at otherfrequencies including, for example, about 31 kHz or about 80 kHz. Theexcursion of the vibrations at the blade can be controlled by, forexample, controlling the amplitude of the electrical signal applied tothe transducer assembly of the acoustic assembly by the generator 20. Asnoted above, the triggering mechanism of the generator 20 allows a userto activate the generator 20 so that electrical energy may becontinuously or intermittently supplied to the acoustic assembly. Thegenerator 20 also has a power line for insertion in an electrosurgicalunit or conventional electrical outlet. It is contemplated that thegenerator 20 can also be powered by a direct current (DC) source, suchas a battery. The generator 20 can comprise any suitable generator, suchas Model No. GEN04, and/or Model No. GEN11 available from EthiconEndo-Surgery, Inc.

FIG. 2 is a left perspective view of one example embodiment of theultrasonic surgical instrument 10 showing the handle assembly 12, thedistal rotation assembly 13, the elongated shaft assembly 14, and theend effector assembly 26. In the illustrated embodiment the elongatedshaft assembly 14 comprises a distal end 52 dimensioned to mechanicallyengage the end effector assembly 26 and a proximal end 50 thatmechanically engages the handle assembly 12 and the distal rotationassembly 13. The proximal end 50 of the elongated shaft assembly 14 isreceived within the handle assembly 12 and the distal rotation assembly13. More details relating to the connections between the elongated shaftassembly 14, the handle assembly 12, and the distal rotation assembly 13are provided in the description of FIGS. 5 and 7.

In the illustrated embodiment, the trigger assembly 24 comprises atrigger 32 that operates in conjunction with a fixed handle 34. Thefixed handle 34 and the trigger 32 are ergonomically formed and adaptedto interface comfortably with the user. The fixed handle 34 isintegrally associated with the handle assembly 12. The trigger 32 ispivotally movable relative to the fixed handle 34 as explained in moredetail below with respect to the operation of the ultrasonic surgicalinstrument 10. The trigger 32 is pivotally movable in direction 33Atoward the fixed handle 34 when the user applies a squeezing forceagainst the trigger 32. A spring element 98 (FIG. 5) causes the trigger32 to pivotally move in direction 33B when the user releases thesqueezing force against the trigger 32.

In one example embodiment, the trigger 32 comprises an elongated triggerhook 36, which defines an aperture 38 between the elongated trigger hook36 and the trigger 32. The aperture 38 is suitably sized to receive oneor multiple fingers of the user therethrough. The trigger 32 also maycomprise a resilient portion 32 a molded over the trigger 32 substrate.The resilient portion 32 a is formed to provide a more comfortablecontact surface for control of the trigger 32 in outward direction 33B.In one example embodiment, the resilient portion 32 a may also beprovided over a portion of the elongated trigger hook 36 as shown, forexample, in FIG. 2. The proximal surface of the elongated trigger hook32 remains uncoated or coated with a non-resilient substrate to enablethe user to easily slide their fingers in and out of the aperture 38. Inanother embodiment, the geometry of the trigger forms a fully closedloop which defines an aperture suitably sized to receive one or multiplefingers of the user therethrough. The fully closed loop trigger also maycomprise a resilient portion molded over the trigger substrate.

In one example embodiment, the fixed handle 34 comprises a proximalcontact surface 40 and a grip anchor or saddle surface 42. The saddlesurface 42 rests on the web where the thumb and the index finger arejoined on the hand. The proximal contact surface 40 has a pistol gripcontour that receives the palm of the hand in a normal pistol grip withno rings or apertures. The profile curve of the proximal contact surface40 may be contoured to accommodate or receive the palm of the hand. Astabilization tail 44 is located towards a more proximal portion of thehandle assembly 12. The stabilization tail 44 may be in contact with theuppermost web portion of the hand located between the thumb and theindex finger to stabilize the handle assembly 12 and make the handleassembly 12 more controllable.

In one example embodiment, the switch assembly 28 may comprise a toggleswitch 30. The toggle switch 30 may be implemented as a single componentwith a central pivot 304 located within inside the handle assembly 12 toeliminate the possibility of simultaneous activation. In one exampleembodiment, the toggle switch 30 comprises a first projecting knob 30 aand a second projecting knob 30 b to set the power setting of theultrasonic transducer 16 between a minimum power level (e.g., MIN) and amaximum power level (e.g., MAX). In another embodiment, the rockerswitch may pivot between a standard setting and a special setting. Thespecial setting may allow one or more special programs to be implementedby the device. The toggle switch 30 rotates about the central pivot asthe first projecting knob 30 a and the second projecting knob 30 b areactuated. The one or more projecting knobs 30 a, 30 b are coupled to oneor more arms that move through a small arc and cause electrical contactsto close or open an electric circuit to electrically energize orde-energize the ultrasonic transducer 16 in accordance with theactivation of the first or second projecting knobs 30 a, 30 b. Thetoggle switch 30 is coupled to the generator 20 to control theactivation of the ultrasonic transducer 16. The toggle switch 30comprises one or more electrical power setting switches to activate theultrasonic transducer 16 to set one or more power settings for theultrasonic transducer 16. The forces required to activate the toggleswitch 30 are directed substantially toward the saddle point 42, thusavoiding any tendency of the instrument to rotate in the hand when thetoggle switch 30 is activated.

In one example embodiment, the first and second projecting knobs 30 a,30 b are located on the distal end of the handle assembly 12 such thatthey can be easily accessible by the user to activate the power withminimal, or substantially no, repositioning of the hand grip, making itsuitable to maintain control and keep attention focused on the surgicalsite (e.g., a monitor in a laparoscopic procedure) while activating thetoggle switch 30. The projecting knobs 30 a, 30 b may be configured towrap around the side of the handle assembly 12 to some extent to be moreeasily accessible by variable finger lengths and to allow greaterfreedom of access to activation in awkward positions or for shorterfingers.

In the illustrated embodiment, the first projecting knob 30 a comprisesa plurality of tactile elements 30 c, e.g., textured projections or“bumps” in the illustrated embodiment, to allow the user todifferentiate the first projecting knob 30 a from the second projectingknob 30 b. It will be appreciated by those skilled in the art thatseveral ergonomic features may be incorporated into the handle assembly12. Such ergonomic features are described in U.S. Pat. App. Pub. No.2009/0105750 entitled ERGONOMIC SURGICAL INSTRUMENTS, now U.S. Pat. No.8,623,027 which is incorporated by reference herein in its entirety.

In one example embodiment, the toggle switch 30 may be operated by thehand of the user. The user may easily access the first and secondprojecting knobs 30 a, 30 b at any point while also avoiding inadvertentor unintentional activation at any time. The toggle switch 30 mayreadily operated with a finger to control the power to the ultrasonicassembly 16 and/or to the ultrasonic assembly 16. For example, the indexfinger may be employed to activate the first contact portion 30 a toturn on the ultrasonic assembly 16 to a maximum (MAX) power level. Theindex finger may be employed to activate the second contact portion 30 bto turn on the ultrasonic assembly 16 to a minimum (MIN) power level. Inanother embodiment, the rocker switch may pivot the instrument 10between a standard setting and a special setting. The special settingmay allow one or more special programs to be implemented by theinstrument 10. The toggle switch 30 may be operated without the userhaving to look at the first or second projecting knob 30 a, 30 b. Forexample, the first projecting knob 30 a or the second projecting knob 30b may comprise a texture or projections to tactilely differentiatebetween the first and second projecting knobs 30 a, 30 b withoutlooking.

In one example embodiment, the distal rotation assembly 13 is rotatablewithout limitation in either direction about a longitudinal axis “T.”The distal rotation assembly 13 is mechanically engaged to the elongatedshaft assembly 14. The distal rotation assembly 13 is located on adistal end of the handle assembly 12. The distal rotation assembly 13comprises a cylindrical hub 46 and a rotation knob 48 formed over thehub 46. The hub 46 mechanically engages the elongated shaft assembly 14.The rotation knob 48 may comprise fluted polymeric features and may beengaged by a finger (e.g., an index finger) to rotate the elongatedshaft assembly 14. The hub 46 may comprise a material molded over theprimary structure to form the rotation knob 48. The rotation knob 48 maybe overmolded over the hub 46. The hub 46 comprises an end cap portion46 a that is exposed at the distal end. The end cap portion 46 a of thehub 46 may contact the surface of a trocar during laparoscopicprocedures. The hub 46 may be formed of a hard durable plastic such aspolycarbonate to alleviate any friction that may occur between the endcap portion 46 a and the trocar. The rotation knob 48 may comprise“scallops” or flutes formed of raised ribs 48 a and concave portions 48b located between the ribs 48 a to provide a more precise rotationalgrip. In one example embodiment, the rotation knob 48 may comprise aplurality of flutes (e.g., three or more flutes). In other embodiments,any suitable number of flutes may be employed. The rotation knob 48 maybe formed of a softer polymeric material overmolded onto the hardplastic material. For example, the rotation knob 48 may be formed ofpliable, resilient, flexible polymeric materials including Versaflex®TPE alloys made by GLS Corporation, for example. This softer overmoldedmaterial may provide a greater grip and more precise control of themovement of the rotation knob 48. It will be appreciated that anymaterials that provide adequate resistance to sterilization, arebiocompatible, and provide adequate frictional resistance to surgicalgloves may be employed to form the rotation knob 48.

In one example embodiment, the handle assembly 12 is formed from two (2)housing portions or shrouds comprising a first portion 12 a and a secondportion 12 b. From the perspective of a user viewing the handle assembly12 from the distal end towards the proximal end, the first portion 12 ais considered the right portion and the second portion 12 b isconsidered the left portion. Each of the first and second portions 12 a,12 b includes a plurality of interfaces 69 (FIG. 7) dimensioned tomechanically align and engage each another to form the handle assembly12 and enclosing the internal working components thereof. The fixedhandle 34, which is integrally associated with the handle assembly 12,takes shape upon the assembly of the first and second portions 12 a and12 b of the handle assembly 12. A plurality of additional interfaces(not shown) may be disposed at various points around the periphery ofthe first and second portions 12 a and 12 b of the handle assembly 12for ultrasonic welding purposes, e.g., energy direction/deflectionpoints. The first and second portions 12 a and 12 b (as well as theother components described below) may be assembled together in anyfashion known in the art. For example, alignment pins, snap-likeinterfaces, tongue and groove interfaces, locking tabs, adhesive ports,may all be utilized either alone or in combination for assemblypurposes.

In one example embodiment, the elongated shaft assembly 14 comprises aproximal end 50 adapted to mechanically engage the handle assembly 12and the distal rotation assembly 13; and a distal end 52 adapted tomechanically engage the end effector assembly 26. The elongated shaftassembly 14 comprises an outer tubular sheath 56 and a reciprocatingtubular actuating member 58 located within the outer tubular sheath 56.The proximal end of the tubular reciprocating tubular actuating member58 is mechanically engaged to the trigger 32 of the handle assembly 12to move in either direction 60A or 60B in response to the actuationand/or release of the trigger 32. The pivotably moveable trigger 32 maygenerate reciprocating motion along the longitudinal axis “T.” Suchmotion may be used, for example, to actuate the jaws or clampingmechanism of the end effector assembly 26. A series of linkagestranslate the pivotal rotation of the trigger 32 to axial movement of ayoke coupled to an actuation mechanism, which controls the opening andclosing of the jaws of the clamping mechanism of the end effectorassembly 26. The distal end of the tubular reciprocating tubularactuating member 58 is mechanically engaged to the end effector assembly26. In the illustrated embodiment, the distal end of the tubularreciprocating tubular actuating member 58 is mechanically engaged to aclamp arm assembly 64, which is pivotable about a pivot point 70, toopen and close the clamp arm assembly 64 in response to the actuationand/or release of the trigger 32. For example, in the illustratedembodiment, the clamp arm assembly 64 is movable in direction 62A froman open position to a closed position about a pivot point 70 when thetrigger 32 is squeezed in direction 33A. The clamp arm assembly 64 ismovable in direction 62B from a closed position to an open positionabout the pivot point 70 when the trigger 32 is released or outwardlycontacted in direction 33B.

In one example embodiment, the end effector assembly 26 is attached atthe distal end 52 of the elongated shaft assembly 14 and includes aclamp arm assembly 64 and a blade 66. The jaws of the clamping mechanismof the end effector assembly 26 are formed by clamp arm assembly 64 andthe blade 66. The blade 66 is ultrasonically actuatable and isacoustically coupled to the ultrasonic transducer 16. The trigger 32 onthe handle assembly 12 is ultimately connected to a drive assembly,which together, mechanically cooperate to effect movement of the clamparm assembly 64. Squeezing the trigger 32 in direction 33A moves theclamp arm assembly 64 in direction 62A from an open position, whereinthe clamp arm assembly 64 and the blade 66 are disposed in a spacedrelation relative to one another, to a clamped or closed position,wherein the clamp arm assembly 64 and the blade 66 cooperate to grasptissue therebetween. The clamp arm assembly 64 may comprise a clamp pad(not shown) to engage tissue between the blade 66 and the clamp arm 64.Releasing the trigger 32 in direction 33B moves the clamp arm assembly64 in direction 62B from a closed relationship, to an open position,wherein the clamp arm assembly 64 and the blade 66 are disposed in aspaced relation relative to one another.

The proximal portion of the handle assembly 12 comprises a proximalopening 68 to receive the distal end of the ultrasonic assembly 16. Theultrasonic assembly 16 is inserted in the proximal opening 68 and ismechanically engaged to the elongated shaft assembly 14.

In one example embodiment, the elongated trigger hook 36 portion of thetrigger 32 provides a longer trigger lever with a shorter span androtation travel. The longer lever of the elongated trigger hook 36allows the user to employ multiple fingers within the aperture 38 tooperate the elongated trigger hook 36 and cause the trigger 32 to pivotin direction 33B to open the jaws of the end effector assembly 26. Forexample, the user may insert three fingers (e.g., the middle, ring, andlittle fingers) in the aperture 38. Multiple fingers allows the surgeonto exert higher input forces on the trigger 32 and the elongated triggerhook 326 to activate the end effector assembly 26. The shorter span androtation travel creates a more comfortable grip when closing orsqueezing the trigger 32 in direction 33A or when opening the trigger 32in the outward opening motion in direction 33B lessening the need toextend the fingers further outward. This substantially lessens handfatigue and strain associated with the outward opening motion of thetrigger 32 in direction 33B. The outward opening motion of the triggermay be spring-assisted by spring element 98 (FIG. 5) to help alleviatefatigue. The opening spring force is sufficient to assist the ease ofopening, but not strong enough to adversely impact the tactile feedbackof tissue tension during spreading dissection.

For example, during a surgical procedure the index finger may be used tocontrol the rotation of the elongated shaft assembly 14 to locate thejaws of the end effector assembly 26 in a suitable orientation. Themiddle and/or the other lower fingers may be used to squeeze the trigger32 and grasp tissue within the jaws. Once the jaws are located in thedesired position and the jaws are clamped against the tissue, the indexfinger can be used to activate the toggle switch 30 to adjust the powerlevel of the ultrasonic transducer 16 to treat the tissue. Once thetissue has been treated, the user may release the trigger 32 by pushingoutwardly in the distal direction against the elongated trigger hook 36with the middle and/or lower fingers to open the jaws of the endeffector assembly 26. This basic procedure may be performed without theuser having to adjust their grip of the handle assembly 12.

FIGS. 3-4 illustrate the connection of the elongated shaft assembly 14relative to the end effector assembly 26. As previously described, inthe illustrated embodiment, the end effector assembly 26 comprises aclamp arm assembly 64 and a blade 66 to form the jaws of the clampingmechanism. The blade 66 may be an ultrasonically actuatable bladeacoustically coupled to the ultrasonic transducer 16. The trigger 32 ismechanically connected to a drive assembly. Together, the trigger 32 andthe drive assembly mechanically cooperate to move the clamp arm assembly64 to an open position in direction 62A wherein the clamp arm assembly64 and the blade 66 are disposed in spaced relation relative to oneanother, to a clamped or closed position in direction 62B wherein theclamp arm assembly 64 and the blade 66 cooperate to grasp tissuetherebetween. The clamp arm assembly 64 may comprise a clamp pad (notshown) to engage tissue between the blade 66 and the clamp arm 64. Thedistal end of the tubular reciprocating tubular actuating member 58 ismechanically engaged to the end effector assembly 26. In the illustratedembodiment, the distal end of the tubular reciprocating tubularactuating member 58 is mechanically engaged to the clamp arm assembly64, which is pivotable about the pivot point 70, to open and close theclamp arm assembly 64 in response to the actuation and/or release of thetrigger 32. For example, in the illustrated embodiment, the clamp armassembly 64 is movable from an open position to a closed position indirection 62B about a pivot point 70 when the trigger 32 is squeezed indirection 33A. The clamp arm assembly 64 is movable from a closedposition to an open position in direction 62A about the pivot point 70when the trigger 32 is released or outwardly contacted in direction 33B.

As previously discussed, the clamp arm assembly 64 may compriseelectrodes electrically coupled to the electrosurgical/RF generatormodule 23 to receive therapeutic and/or sub-therapeutic energy, wherethe electrosurgical/RF energy may be applied to the electrodes eithersimultaneously or non simultaneously with the ultrasonic energy beingapplied to the blade 66. Such energy activations may be applied in anysuitable combinations to achieve a desired tissue effect in cooperationwith an algorithm or other control logic.

FIG. 5 is an exploded view of the ultrasonic surgical instrument 10shown in FIG. 2. In the illustrated embodiment, the exploded view showsthe internal elements of the handle assembly 12, the handle assembly 12,the distal rotation assembly 13, the switch assembly 28, and theelongated shaft assembly 14. In the illustrated embodiment, the firstand second portions 12 a, 12 b mate to form the handle assembly 12. Thefirst and second portions 12 a, 12 b each comprises a plurality ofinterfaces 69 dimensioned to mechanically align and engage one anotherto form the handle assembly 12 and enclose the internal workingcomponents of the ultrasonic surgical instrument 10. The rotation knob48 is mechanically engaged to the outer tubular sheath 56 so that it maybe rotated in circular direction 54 up to 360°. The outer tubular sheath56 is located over the reciprocating tubular actuating member 58, whichis mechanically engaged to and retained within the handle assembly 12via a plurality of coupling elements 72. The coupling elements 72 maycomprise an O-ring 72 a, a tube collar cap 72 b, a distal washer 72 c, aproximal washer 72 d, and a thread tube collar 72 e. The reciprocatingtubular actuating member 58 is located within a reciprocating yoke 84,which is retained between the first and second portions 12 a, 12 b ofthe handle assembly 12. The yoke 84 is part of a reciprocating yokeassembly 88. A series of linkages translate the pivotal rotation of theelongated trigger hook 32 to the axial movement of the reciprocatingyoke 84, which controls the opening and closing of the jaws of theclamping mechanism of the end effector assembly 26 at the distal end ofthe ultrasonic surgical instrument 10. In one example embodiment, afour-link design provides mechanical advantage in a relatively shortrotation span, for example.

In one example embodiment, an ultrasonic transmission waveguide 78 isdisposed inside the reciprocating tubular actuating member 58. Thedistal end 52 of the ultrasonic transmission waveguide 78 isacoustically coupled (e.g., directly or indirectly mechanically coupled)to the blade 66 and the proximal end 50 of the ultrasonic transmissionwaveguide 78 is received within the handle assembly 12. The proximal end50 of the ultrasonic transmission waveguide 78 is adapted toacoustically couple to the distal end of the ultrasonic transducer 16 asdiscussed in more detail below. The ultrasonic transmission waveguide 78is isolated from the other elements of the elongated shaft assembly 14by a protective sheath 80 and a plurality of isolation elements 82, suchas silicone rings. The outer tubular sheath 56, the reciprocatingtubular actuating member 58, and the ultrasonic transmission waveguide78 are mechanically engaged by a pin 74. The switch assembly 28comprises the toggle switch 30 and electrical elements 86 a,b toelectrically energize the ultrasonic transducer 16 in accordance withthe activation of the first or second projecting knobs 30 a, 30 b.

In one example embodiment, the outer tubular sheath 56 isolates the useror the patient from the ultrasonic vibrations of the ultrasonictransmission waveguide 78. The outer tubular sheath 56 generallyincludes a hub 76. The outer tubular sheath 56 is threaded onto thedistal end of the handle assembly 12. The ultrasonic transmissionwaveguide 78 extends through the opening of the outer tubular sheath 56and the isolation elements 82 isolate the ultrasonic transmissionwaveguide 78 from the outer tubular sheath 56. The outer tubular sheath56 may be attached to the waveguide 78 with the pin 74. The hole toreceive the pin 74 in the waveguide 78 may occur nominally at adisplacement node. The waveguide 78 may screw or snap into the handpiece handle assembly 12 by a stud. Flat portions on the hub 76 mayallow the assembly to be torqued to a required level. In one exampleembodiment, the hub 76 portion of the outer tubular sheath 56 ispreferably constructed from plastic and the tubular elongated portion ofthe outer tubular sheath 56 is fabricated from stainless steel.Alternatively, the ultrasonic transmission waveguide 78 may comprisepolymeric material surrounding it to isolate it from outside contact.

In one example embodiment, the distal end of the ultrasonic transmissionwaveguide 78 may be coupled to the proximal end of the blade 66 by aninternal threaded connection, preferably at or near an antinode. It iscontemplated that the blade 66 may be attached to the ultrasonictransmission waveguide 78 by any suitable means, such as a welded jointor the like. Although the blade 66 may be detachable from the ultrasonictransmission waveguide 78, it is also contemplated that the singleelement end effector (e.g., the blade 66) and the ultrasonictransmission waveguide 78 may be formed as a single unitary piece.

In one example embodiment, the trigger 32 is coupled to a linkagemechanism to translate the rotational motion of the trigger 32 indirections 33A and 33B to the linear motion of the reciprocating tubularactuating member 58 in corresponding directions 60A and 60B. The trigger32 comprises a first set of flanges 97 with openings formed therein toreceive a first yoke pin 94 a. The first yoke pin 94 a is also locatedthrough a set of openings formed at the distal end of the yoke 84. Thetrigger 32 also comprises a second set of flanges 96 to receive a firstend 92 a of a link 92. A trigger pin 90 is received in openings formedin the link 92 and the second set of flanges 96. The trigger pin 90 isreceived in the openings formed in the link 92 and the second set offlanges 96 and is adapted to couple to the first and second portions 12a, 12 b of the handle assembly 12 to form a trigger pivot point for thetrigger 32. A second end 92 b of the link 92 is received in a slot 93formed in a proximal end of the yoke 84 and is retained therein by asecond yoke pin 94 b. As the trigger 32 is pivotally rotated about thepivot point 190 formed by the trigger pin 90, the yoke translateshorizontally along longitudinal axis “T” in a direction indicated byarrows 60A,B.

FIG. 8 illustrates one example embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, a cross-sectional view ofthe ultrasonic transducer 16 is shown within a partial cutaway view ofthe handle assembly 12. One example embodiment of the ultrasonicsurgical instrument 10 comprises the ultrasonic signal generator 20coupled to the ultrasonic transducer 16, comprising a hand piece housing99, and an ultrasonically actuatable single or multiple element endeffector assembly 26. As previously discussed, the end effector assembly26 comprises the ultrasonically actuatable blade 66 and the clamp arm64. The ultrasonic transducer 16, which is known as a “Langevin stack”,generally includes a transduction portion 100, a first resonator portionor end-bell 102, and a second resonator portion or fore-bell 104, andancillary components. The total construction of these components is aresonator. The ultrasonic transducer 16 is preferably an integral numberof one-half system wavelengths (nλ/2; where “n” is any positive integer;e.g., n=1, 2, 3 . . . ) in length as will be described in more detaillater. An acoustic assembly 106 includes the ultrasonic transducer 16, anose cone 108, a velocity transformer 118, and a surface 110.

In one example embodiment, the distal end of the end-bell 102 isconnected to the proximal end of the transduction portion 100, and theproximal end of the fore-bell 104 is connected to the distal end of thetransduction portion 100. The fore-bell 104 and the end-bell 102 have alength determined by a number of variables, including the thickness ofthe transduction portion 100, the density and modulus of elasticity ofthe material used to manufacture the end-bell 102 and the fore-bell 22,and the resonant frequency of the ultrasonic transducer 16. Thefore-bell 104 may be tapered inwardly from its proximal end to itsdistal end to amplify the ultrasonic vibration amplitude as the velocitytransformer 118, or alternately may have no amplification. A suitablevibrational frequency range may be about 20 Hz to 32 kHz and awell-suited vibrational frequency range may be about 30-10 kHz. Asuitable operational vibrational frequency may be approximately 55.5kHz, for example.

In one example embodiment, the piezoelectric elements 112 may befabricated from any suitable material, such as, for example, leadzirconate-titanate, lead meta-niobate, lead titanate, barium titanate,or other piezoelectric ceramic material. Each of positive electrodes114, negative electrodes 116, and the piezoelectric elements 112 has abore extending through the center. The positive and negative electrodes114 and 116 are electrically coupled to wires 120 and 122, respectively.The wires 120 and 122 are encased within the cable 22 and electricallyconnectable to the ultrasonic signal generator 20.

The ultrasonic transducer 16 of the acoustic assembly 106 converts theelectrical signal from the ultrasonic signal generator 20 intomechanical energy that results in primarily a standing acoustic wave oflongitudinal vibratory motion of the ultrasonic transducer 16 and theblade 66 portion of the end effector assembly 26 at ultrasonicfrequencies. In another embodiment, the vibratory motion of theultrasonic transducer may act in a different direction. For example, thevibratory motion may comprise a local longitudinal component of a morecomplicated motion of the tip of the elongated shaft assembly 14. Asuitable generator is available as model number GEN11, from EthiconEndo-Surgery, Inc., Cincinnati, Ohio. When the acoustic assembly 106 isenergized, a vibratory motion standing wave is generated through theacoustic assembly 106. The ultrasonic surgical instrument 10 is designedto operate at a resonance such that an acoustic standing wave pattern ofpredetermined amplitude is produced. The amplitude of the vibratorymotion at any point along the acoustic assembly 106 depends upon thelocation along the acoustic assembly 106 at which the vibratory motionis measured. A minimum or zero crossing in the vibratory motion standingwave is generally referred to as a node (i.e., where motion is minimal),and a local absolute value maximum or peak in the standing wave isgenerally referred to as an anti-node (e.g., where local motion ismaximal). The distance between an anti-node and its nearest node isone-quarter wavelength (λ/4).

The wires 120 and 122 transmit an electrical signal from the ultrasonicsignal generator 20 to the positive electrodes 114 and the negativeelectrodes 116. The piezoelectric elements 112 are energized by theelectrical signal supplied from the ultrasonic signal generator 20 inresponse to an actuator 224, such as a foot switch, for example, toproduce an acoustic standing wave in the acoustic assembly 106. Theelectrical signal causes disturbances in the piezoelectric elements 112in the form of repeated small displacements resulting in largealternating compression and tension forces within the material. Therepeated small displacements cause the piezoelectric elements 112 toexpand and contract in a continuous manner along the axis of the voltagegradient, producing longitudinal waves of ultrasonic energy. Theultrasonic energy is transmitted through the acoustic assembly 106 tothe blade 66 portion of the end effector assembly 26 via a transmissioncomponent or an ultrasonic transmission waveguide portion 78 of theelongated shaft assembly 14.

In one example embodiment, in order for the acoustic assembly 106 todeliver energy to the blade 66 portion of the end effector assembly 26,all components of the acoustic assembly 106 must be acoustically coupledto the blade 66. The distal end of the ultrasonic transducer 16 may beacoustically coupled at the surface 110 to the proximal end of theultrasonic transmission waveguide 78 by a threaded connection such as astud 124.

In one example embodiment, the components of the acoustic assembly 106are preferably acoustically tuned such that the length of any assemblyis an integral number of one-half wavelengths (nλ/2), where thewavelength λ is the wavelength of a pre-selected or operatinglongitudinal vibration drive frequency f_(d) of the acoustic assembly106. It is also contemplated that the acoustic assembly 106 mayincorporate any suitable arrangement of acoustic elements.

In one example embodiment, the blade 66 may have a length substantiallyequal to an integral multiple of one-half system wavelengths (nλ/2). Adistal end of the blade 66 may be disposed near an antinode in order toprovide the maximum longitudinal excursion of the distal end. When thetransducer assembly is energized, the distal end of the blade 66 may beconfigured to move in the range of, for example, approximately 10 to 500microns peak-to-peak, and preferably in the range of about 30 to 64microns at a predetermined vibrational frequency of 55 kHz, for example.

In one example embodiment, the blade 66 may be coupled to the ultrasonictransmission waveguide 78. The blade 66 and the ultrasonic transmissionwaveguide 78 as illustrated are formed as a single unit constructionfrom a material suitable for transmission of ultrasonic energy. Examplesof such materials include Ti6Al4V (an alloy of Titanium includingAluminum and Vanadium), Aluminum, Stainless Steel, or other suitablematerials. Alternately, the blade 66 may be separable (and of differingcomposition) from the ultrasonic transmission waveguide 78, and coupledby, for example, a stud, weld, glue, quick connect, or other suitableknown methods. The length of the ultrasonic transmission waveguide 78may be substantially equal to an integral number of one-half wavelengths(nλ/2), for example. The ultrasonic transmission waveguide 78 may bepreferably fabricated from a solid core shaft constructed out ofmaterial suitable to propagate ultrasonic energy efficiently, such asthe titanium alloy discussed above (i.e., Ti6Al4V) or any suitablealuminum alloy, or other alloys, for example.

In one example embodiment, the ultrasonic transmission waveguide 78comprises a longitudinally projecting attachment post at a proximal endto couple to the surface 110 of the ultrasonic transmission waveguide 78by a threaded connection such as the stud 124. The ultrasonictransmission waveguide 78 may include a plurality of stabilizingsilicone rings or compliant supports 82 (FIG. 5) positioned at aplurality of nodes. The silicone rings 82 dampen undesirable vibrationand isolate the ultrasonic energy from an outer protective sheath 80(FIG. 5) assuring the flow of ultrasonic energy in a longitudinaldirection to the distal end of the blade 66 with maximum efficiency.

FIG. 9 illustrates one example embodiment of the proximal rotationassembly 128. In the illustrated embodiment, the proximal rotationassembly 128 comprises the proximal rotation knob 134 inserted over thecylindrical hub 135. The proximal rotation knob 134 comprises aplurality of radial projections 138 that are received in correspondingslots 130 formed on a proximal end of the cylindrical hub 135. Theproximal rotation knob 134 defines an opening 142 to receive the distalend of the ultrasonic transducer 16. The radial projections 138 areformed of a soft polymeric material and define a diameter that isundersized relative to the outside diameter of the ultrasonic transducer16 to create a friction interference fit when the distal end of theultrasonic transducer 16. The polymeric radial projections 138 protruderadially into the opening 142 to form “gripper” ribs that firmly gripthe exterior housing of the ultrasonic transducer 16. Therefore, theproximal rotation knob 134 securely grips the ultrasonic transducer 16.

The distal end of the cylindrical hub 135 comprises a circumferentiallip 132 and a circumferential bearing surface 140. The circumferentiallip engages a groove formed in the housing 12 and the circumferentialbearing surface 140 engages the housing 12. Thus, the cylindrical hub135 is mechanically retained within the two housing portions (not shown)of the housing 12. The circumferential lip 132 of the cylindrical hub135 is located or “trapped” between the first and second housingportions 12 a, 12 b and is free to rotate in place within the groove.The circumferential bearing surface 140 bears against interior portionsof the housing to assist proper rotation. Thus, the cylindrical hub 135is free to rotate in place within the housing. The user engages theflutes 136 formed on the proximal rotation knob 134 with either thefinger or the thumb to rotate the cylindrical hub 135 within the housing12.

In one example embodiment, the cylindrical hub 135 may be formed of adurable plastic such as polycarbonate. In one example embodiment, thecylindrical hub 135 may be formed of a siliconized polycarbonatematerial. In one example embodiment, the proximal rotation knob 134 maybe formed of pliable, resilient, flexible polymeric materials includingVersaflex® TPE alloys made by GLS Corporation, for example. The proximalrotation knob 134 may be formed of elastomeric materials, thermoplasticrubber known as Santoprene®, other thermoplastic vulcanizates (TPVs), orelastomers, for example. The embodiments, however, are not limited inthis context.

FIG. 10 illustrates one example embodiment of a surgical system 200including a surgical instrument 210 having single element end effector278. The system 200 may include a transducer assembly 216 coupled to theend effector 278 and a sheath 256 positioned around the proximalportions of the end effector 278 as shown. The transducer assembly 216and end effector 278 may operate in a manner similar to that of thetransducer assembly 16 and end effector 18 described above to produceultrasonic energy that may be transmitted to tissue via blade 226.

Over the years, a variety of minimally invasive robotic (or“telesurgical”) systems have been developed to increase surgicaldexterity as well as to permit a surgeon to operate on a patient in anintuitive manner. Robotic surgical systems can be used with manydifferent types of surgical instruments including, for example,ultrasonic instruments, as described herein. Example robotic systemsinclude those manufactured by Intuitive Surgical, Inc., of Sunnyvale,Calif., U.S.A. Such systems, as well as robotic systems from othermanufacturers, are disclosed in the following U.S. Patents which areeach herein incorporated by reference in their respective entirety: U.S.Pat. No. 5,792,135, entitled “Articulated Surgical Instrument ForPerforming Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”, U.S. Pat. No. 6,231,565, entitled “Robotic Arm DLUs ForPerforming Surgical Tasks”, U.S. Pat. No. 6,783,524, entitled “RoboticSurgical Tool With Ultrasound Cauterizing and Cutting Instrument”, U.S.Pat. No. 6,364,888, entitled “Alignment of Master and Slave In aMinimally Invasive Surgical Apparatus”, U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System For Robotic SurgicalTools”, U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism”, U.S. Pat. No. 7,806,891, entitled “Repositioning andReorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery”, and U.S. Pat. No. 7,824,401, entitled “Surgical Tool WithWristed Monopolar Electrosurgical End Effectors”. Many of such systems,however, have in the past been unable to generate the magnitude offorces required to effectively cut and fasten tissue.

FIGS. 11-26 illustrate example embodiments of robotic surgical systems.In some embodiments, the disclosed robotic surgical systems may utilizethe ultrasonic or electrosurgical instruments described herein. Thoseskilled in the art will appreciate that the illustrated robotic surgicalsystems are not limited to only those instruments described herein, andmay utilize any compatible surgical instruments. Those skilled in theart will further appreciate that while various embodiments describedherein may be used with the described robotic surgical systems, thedisclosure is not so limited, and may be used with any compatiblerobotic surgical system.

FIGS. 11-16 illustrate the structure and operation of several examplerobotic surgical systems and components thereof. FIG. 11 shows a blockdiagram of an example robotic surgical system 500. The system 500comprises at least one controller 508 and at least one arm cart 510. Thearm cart 510 may be mechanically coupled to one or more roboticmanipulators or arms, indicated by box 512. Each of the robotic arms 512may comprise one or more surgical instruments 514 for performing varioussurgical tasks on a patient 504. Operation of the arm cart 510,including the arms 512 and instruments 514 may be directed by aclinician 502 from a controller 508. In some embodiments, a secondcontroller 508′, operated by a second clinician 502′ may also directoperation of the arm cart 510 in conjunction with the first clinician502′. For example, each of the clinicians 502, 502′ may controldifferent arms 512 of the cart or, in some cases, complete control ofthe arm cart 510 may be passed between the clinicians 502, 502′. In someembodiments, additional arm carts (not shown) may be utilized on thepatient 504. These additional arm carts may be controlled by one or moreof the controllers 508, 508′. The arm cart(s) 510 and controllers 508,508′ may be in communication with one another via a communications link516, which may be any suitable type of wired or wireless communicationslink carrying any suitable type of signal (e.g., electrical, optical,infrared, etc.) according to any suitable communications protocol.Example implementations of robotic surgical systems, such as the system500, are disclosed in U.S. Pat. No. 7,524,320 which has been hereinincorporated by reference. Thus, various details of such devices willnot be described in detail herein beyond that which may be necessary tounderstand various embodiments of the claimed device.

FIG. 12 shows one example embodiment of a robotic arm cart 520. Therobotic arm cart 520 is configured to actuate a plurality of surgicalinstruments or instruments, generally designated as 522 within a workenvelope 527. Various robotic surgery systems and methods employingmaster controller and robotic arm cart arrangements are disclosed inU.S. Pat. No. 6,132,368, entitled “Multi-Component Telepresence Systemand Method”, the full disclosure of which is incorporated herein byreference. In various forms, the robotic arm cart 520 includes a base524 from which, in the illustrated embodiment, three surgicalinstruments 522 are supported. In various forms, the surgicalinstruments 522 are each supported by a series of manually articulatablelinkages, generally referred to as set-up joints 526, and a roboticmanipulator 528. These structures are herein illustrated with protectivecovers extending over much of the robotic linkage. These protectivecovers may be optional, and may be limited in size or entirelyeliminated in some embodiments to minimize the inertia that isencountered by the servo mechanisms used to manipulate such devices, tolimit the volume of moving components so as to avoid collisions, and tolimit the overall weight of the cart 520. Cart 520 will generally havedimensions suitable for transporting the cart 520 between operatingrooms. The cart 520 may be configured to typically fit through standardoperating room doors and onto standard hospital elevators. In variousforms, the cart 520 would preferably have a weight and include a wheel(or other transportation) system that allows the cart 520 to bepositioned adjacent an operating table by a single attendant.

FIG. 13 shows one example embodiment of the robotic manipulator 528 ofthe robotic arm cart 520. In the example shown in FIG. 13, the roboticmanipulators 528 may include a linkage 530 that constrains movement ofthe surgical instrument 522. In various embodiments, linkage 530includes rigid links coupled together by rotational joints in aparallelogram arrangement so that the surgical instrument 522 rotatesaround a point in space 532, as more fully described in issued U.S. Pat.No. 5,817,084, the full disclosure of which is herein incorporated byreference. The parallelogram arrangement constrains rotation to pivotingabout an axis 534 a, sometimes called the pitch axis. The linkssupporting the parallelogram linkage are pivotally mounted to set-upjoints 526 (FIG. 12) so that the surgical instrument 522 further rotatesabout an axis 534 b, sometimes called the yaw axis. The pitch and yawaxes 534 a, 534 b intersect at the remote center 536, which is alignedalong a shaft 538 of the surgical instrument 522. The surgicalinstrument 522 may have further degrees of driven freedom as supportedby manipulator 540, including sliding motion of the surgical instrument522 along the longitudinal instrument axis “LT-LT”. As the surgicalinstrument 522 slides along the instrument axis LT-LT relative tomanipulator 540 (arrow 534 c), remote center 536 remains fixed relativeto base 542 of manipulator 540. Hence, the entire manipulator 540 isgenerally moved to re-position remote center 536. Linkage 530 ofmanipulator 540 is driven by a series of motors 544. These motors 544actively move linkage 530 in response to commands from a processor of acontrol system. As will be discussed in further detail below, motors 544are also employed to manipulate the surgical instrument 522.

FIG. 14 shows one example embodiment of a robotic arm cart 520′ havingan alternative set-up joint structure. In this example embodiment, asurgical instrument 522 is supported by an alternative manipulatorstructure 528′ between two tissue manipulation instruments. Those ofordinary skill in the art will appreciate that various embodiments ofthe claimed device may incorporate a wide variety of alternative roboticstructures, including those described in U.S. Pat. No. 5,878,193, thefull disclosure of which is incorporated herein by reference.Additionally, while the data communication between a robotic componentand the processor of the robotic surgical system is primarily describedherein with reference to communication between the surgical instrument522 and the controller, it should be understood that similarcommunication may take place between circuitry of a manipulator, aset-up joint, an endoscope or other image capture device, or the like,and the processor of the robotic surgical system for componentcompatibility verification, component-type identification, componentcalibration (such as off-set or the like) communication, confirmation ofcoupling of the component to the robotic surgical system, or the like.

FIG. 15 shows one example embodiment of a controller 518 that may beused in conjunction with a robotic arm cart, such as the robotic armcarts 520, 520′ depicted in FIGS. 12-14. The controller 518 generallyincludes master controllers (generally represented as 519 in FIG. 15)which are grasped by the clinician and manipulated in space while theclinician views the procedure via a stereo display 521. A surgeon feedback meter 515 may be viewed via the display 521 and provide the surgeonwith a visual indication of the amount of force being applied to thecutting instrument or dynamic clamping member. The master controllers519 generally comprise manual input devices which preferably move withmultiple degrees of freedom, and which often further have a handle ortrigger for actuating instruments (for example, for closing graspingsaws, applying an electrical potential to an electrode, or the like).

FIG. 16 shows one example embodiment of an ultrasonic surgicalinstrument 522 adapted for use with a robotic surgical system. Forexample, the surgical instrument 522 may be coupled to one of thesurgical manipulators 528, 528′ described hereinabove. As can be seen inFIG. 16, the surgical instrument 522 comprises a surgical end effector548 that comprises an ultrasonic blade 550 and clamp arm 552, which maybe coupled to an elongated shaft assembly 554 that, in some embodiments,may comprise an articulation joint 556. FIG. 17 shows one exampleembodiment of an instrument drive assembly 546 that may be coupled toone of the surgical manipulators 528, 528′ to receive and control thesurgical instrument 522. The instrument drive assembly 546 may also beoperatively coupled to the controller 518 to receive inputs from theclinician for controlling the instrument 522. For example, actuation(e.g., opening and closing) of the clamp arm 552, actuation (e.g.,opening and closing) of the jaws 551A, 551B, actuation of the ultrasonicblade 550, extension of the knife 555 and actuation of the energydelivery surfaces 553A, 553B, etc. may be controlled through theinstrument drive assembly 546 based on inputs from the clinicianprovided through the controller 518. The surgical instrument 522 isoperably coupled to the manipulator by an instrument mounting portion,generally designated as 558. The surgical instruments 522 furtherinclude an interface 560 which mechanically and electrically couples theinstrument mounting portion 558 to the manipulator.

FIG. 18 shows another view of the instrument drive assembly of FIG. 17including the ultrasonic surgical instrument 522. The instrumentmounting portion 558 includes an instrument mounting plate 562 thatoperably supports a plurality of (four are shown in FIG. 17) rotatablebody portions, driven discs or elements 564, that each include a pair ofpins 566 that extend from a surface of the driven element 564. One pin566 is closer to an axis of rotation of each driven elements 564 thanthe other pin 566 on the same driven element 564, which helps to ensurepositive angular alignment of the driven element 564. The drivenelements 564 and pints 566 may be positioned on an adapter side 567 ofthe instrument mounting plate 562.

Interface 560 also includes an adaptor portion 568 that is configured tomountingly engage the mounting plate 562 as will be further discussedbelow. The adaptor portion 568 may include an array of electricalconnecting pins 570, which may be coupled to a memory structure by acircuit board within the instrument mounting portion 558. Whileinterface 560 is described herein with reference to mechanical,electrical, and magnetic coupling elements, it should be understood thata wide variety of telemetry modalities might be used, includinginfrared, inductive coupling, or the like.

FIGS. 19-21 show additional views of the adapter portion 568 of theinstrument drive assembly 546 of FIG. 17. The adapter portion 568generally includes an instrument side 572 and a holder side 574 (FIG.19). In various embodiments, a plurality of rotatable bodies 576 aremounted to a floating plate 578 which has a limited range of movementrelative to the surrounding adaptor structure normal to the majorsurfaces of the adaptor 568. Axial movement of the floating plate 578helps decouple the rotatable bodies 576 from the instrument mountingportion 558 when the levers 580 along the sides of the instrumentmounting portion housing 582 are actuated (See FIG. 16) Othermechanisms/arrangements may be employed for releasably coupling theinstrument mounting portion 558 to the adaptor 568. In at least oneform, rotatable bodies 576 are resiliently mounted to floating plate 578by resilient radial members which extend into a circumferentialindentation about the rotatable bodies 576. The rotatable bodies 576 canmove axially relative to plate 578 by deflection of these resilientstructures. When disposed in a first axial position (toward instrumentside 572) the rotatable bodies 576 are free to rotate without angularlimitation. However, as the rotatable bodies 576 move axially towardinstrument side 572, tabs 584 (extending radially from the rotatablebodies 576) laterally engage detents on the floating plates so as tolimit angular rotation of the rotatable bodies 576 about their axes.This limited rotation can be used to help drivingly engage the rotatablebodies 576 with drive pins 586 of a corresponding instrument holderportion 588 of the robotic system, as the drive pins 586 will push therotatable bodies 576 into the limited rotation position until the pins586 are aligned with (and slide into) openings 590.

Openings 590 on the instrument side 572 and openings 590 on the holderside 574 of rotatable bodies 576 are configured to accurately align thedriven elements 564 (FIGS. 18, 28) of the instrument mounting portion558 with the drive elements 592 of the instrument holder 588. Asdescribed above regarding inner and outer pins 566 of driven elements564, the openings 590 are at differing distances from the axis ofrotation on their respective rotatable bodies 576 so as to ensure thatthe alignment is not 33 degrees from its intended position.Additionally, each of the openings 590 may be slightly radiallyelongated so as to fittingly receive the pins 566 in the circumferentialorientation. This allows the pins 566 to slide radially within theopenings 590 and accommodate some axial misalignment between theinstrument 522 and instrument holder 588, while minimizing any angularmisalignment and backlash between the drive and driven elements.Openings 590 on the instrument side 572 may be offset by about 90degrees from the openings 590 (shown in broken lines) on the holder side574, as can be seen most clearly in FIG. 21.

Various embodiments may further include an array of electrical connectorpins 570 located on holder side 574 of adaptor 568, and the instrumentside 572 of the adaptor 568 may include slots 594 (FIG. 21) forreceiving a pin array (not shown) from the instrument mounting portion558. In addition to transmitting electrical signals between the surgicalinstrument 522, 523 and the instrument holder 588, at least some ofthese electrical connections may be coupled to an adaptor memory device596 (FIG. 20) by a circuit board of the adaptor 568.

A detachable latch arrangement 598 may be employed to releasably affixthe adaptor 568 to the instrument holder 588. As used herein, the term“instrument drive assembly” when used in the context of the roboticsystem, at least encompasses various embodiments of the adapter 568 andinstrument holder 588 and which has been generally designated as 546 inFIG. 17. For example, as can be seen in FIG. 17, the instrument holder588 may include a first latch pin arrangement 600 that is sized to bereceived in corresponding clevis slots 602 provided in the adaptor 568.In addition, the instrument holder 588 may further have second latchpins 604 that are sized to be retained in corresponding latch devises606 in the adaptor 568. See FIG. 20. In at least one form, a latchassembly 608 is movably supported on the adapter 568 and is biasablebetween a first latched position wherein the latch pins 600 are retainedwithin their respective clevis slot 602 and an unlatched positionwherein the second latch pins 604 may be into or removed from the latchdevises 606. A spring or springs (not shown) are employed to bias thelatch assembly into the latched position. A lip on the instrument side572 of adaptor 568 may slidably receive laterally extending tabs ofinstrument mounting housing 582.

As described the driven elements 564 may be aligned with the driveelements 592 of the instrument holder 588 such that rotational motion ofthe drive elements 592 causes corresponding rotational motion of thedriven elements 564. The rotation of the drive elements 592 and drivenelements 564 may be electronically controlled, for example, via therobotic arm 512, in response to instructions received from the clinician502 via a controller 508. The instrument mounting portion 558 maytranslate rotation of the driven elements 564 into motion of thesurgical instrument 522, 523.

FIGS. 22-24 show one example embodiment of the instrument mountingportion 558 showing components for translating motion of the drivenelements 564 into motion of the surgical instrument 522. FIGS. 22-24show the instrument mounting portion with a shaft 538 having a surgicalend effector 610 at a distal end thereof. The end effector 610 may beany suitable type of end effector for performing a surgical task on apatient. For example, the end effector may be configured to provideultrasonic energy to tissue at a surgical site. The shaft 538 may berotatably coupled to the instrument mounting portion 558 and secured bya top shaft holder 646 and a bottom shaft holder 648 at a coupler 650 ofthe shaft 538.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for translating rotation of the various driven elements 564into rotation of the shaft 538, differential translation of membersalong the axis of the shaft (e.g., for articulation), and reciprocatingtranslation of one or more members along the axis of the shaft 538(e.g., for extending and retracting tissue cutting elements such as 555,overtubes and/or other components). In one example embodiment, therotatable bodies 612 (e.g., rotatable spools) are coupled to the drivenelements 564. The rotatable bodies 612 may be formed integrally with thedriven elements 564. In some embodiments, the rotatable bodies 612 maybe formed separately from the driven elements 564 provided that therotatable bodies 612 and the driven elements 564 are fixedly coupledsuch that driving the driven elements 564 causes rotation of therotatable bodies 612. Each of the rotatable bodies 612 is coupled to agear train or gear mechanism to provide shaft articulation and rotationand clamp jaw open/close and knife actuation.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for causing differential translation of two or more membersalong the axis of the shaft 538. In the example provided in FIGS. 22-24,this motion is used to manipulate articulation joint 556. In theillustrated embodiment, for example, the instrument mounting portion 558comprises a rack and pinion gearing mechanism to provide thedifferential translation and thus the shaft articulation functionality.In one example embodiment, the rack and pinion gearing mechanismcomprises a first pinion gear 614 coupled to a rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the firstpinion gear 614 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the firstpinion gear 614. The first pinion gear 614 is meshed to a first rackgear 618 to convert the rotational motion of the first pinion gear 614into linear motion of the first rack gear 618 to control thearticulation of the articulation section 556 of the shaft assembly 538in a left direction 620L. The first rack gear 618 is attached to a firstarticulation band 622 (FIG. 22) such that linear motion of the firstrack gear 618 in a distal direction causes the articulation section 556of the shaft assembly 538 to articulate in the left direction 620L. Asecond pinion gear 626 is coupled to another rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the secondpinion gear 626 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the secondpinion gear 626. The second pinion gear 626 is meshed to a second rackgear 628 to convert the rotational motion of the second pinion gear 626into linear motion of the second rack gear 628 to control thearticulation of the articulation section 556 in a right direction 620R.The second rack gear 628 is attached to a second articulation band 624(FIG. 23) such that linear motion of the second rack gear 628 in adistal direction causes the articulation section 556 of the shaftassembly 538 to articulate in the right direction 620R. Additionalbearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

In one example embodiment, the instrument mounting portion 558 furthercomprises a mechanism for translating rotation of the driven elements564 into rotational motion about the axis of the shaft 538. For example,the rotational motion may be rotation of the shaft 538 itself. In theillustrated embodiment, a first spiral worm gear 630 coupled to arotatable body 612 and a second spiral worm gear 632 coupled to theshaft assembly 538. A bearing 616 (FIG. 17) is coupled to a rotatablebody 612 and is provided between a driven element 564 and the firstspiral worm gear 630. The first spiral worm gear 630 is meshed to thesecond spiral worm gear 632, which may be coupled to the shaft assembly538 and/or to another component of the instrument 522, 523 for whichlongitudinal rotation is desired. Rotation may be caused in a clockwise(CW) and counterclockwise (CCW) direction based on the rotationaldirection of the first and second spiral worm gears 630, 632.Accordingly, rotation of the first spiral worm gear 630 about a firstaxis is converted to rotation of the second spiral worm gear 632 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.22-23, for example, a CW rotation of the second spiral worm gear 632results in a CW rotation of the shaft assembly 538 in the directionindicated by 634CW. A CCW rotation of the second spiral worm gear 632results in a CCW rotation of the shaft assembly 538 in the directionindicated by 634CCW. Additional bearings may be provided between therotatable bodies and the corresponding gears. Any suitable bearings maybe provided to support and stabilize the mounting and reduce rotaryfriction of shaft and gears, for example.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for generating reciprocating translation of one or moremembers along the axis of the shaft 538. Such translation may be used,for example to drive a tissue cutting element, such as 555, drive anovertube for closure and/or articulation of the end effector 610, etc.In the illustrated embodiment, for example, a rack and pinion gearingmechanism may provide the reciprocating translation. A first gear 636 iscoupled to a rotatable body 612 such that rotation of the correspondingdriven element 564 causes the first gear 636 to rotate in a firstdirection. A second gear 638 is free to rotate about a post 640 formedin the instrument mounting plate 562. The first gear 636 is meshed tothe second gear 638 such that the second gear 638 rotates in a directionthat is opposite of the first gear 636. In one example embodiment, thesecond gear 638 is a pinion gear meshed to a rack gear 642, which movesin a liner direction. The rack gear 642 is coupled to a translatingblock 644, which may translate distally and proximally with the rackgear 642. The translation block 644 may be coupled to any suitablecomponent of the shaft assembly 538 and/or the end effector 610 so as toprovide reciprocating longitudinal motion. For example, the translationblock 644 may be mechanically coupled to the tissue cutting element 555of the RF surgical device 523. In some embodiments, the translationblock 644 may be coupled to an overtube, or other component of the endeffector 610 or shaft 538.

FIGS. 25-27 illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538 and an alternate example mechanism forgenerating reciprocating translation of one or more members along theaxis of the shaft 538. Referring now to the alternate rotationalmechanism, a first spiral worm gear 652 is coupled to a second spiralworm gear 654, which is coupled to a third spiral worm gear 656. Such anarrangement may be provided for various reasons including maintainingcompatibility with existing robotic systems 500 and/or where space maybe limited. The first spiral worm gear 652 is coupled to a rotatablebody 612. The third spiral worm gear 656 is meshed with a fourth spiralworm gear 658 coupled to the shaft assembly 538. A bearing 760 iscoupled to a rotatable body 612 and is provided between a driven element564 and the first spiral worm gear 738. Another bearing 760 is coupledto a rotatable body 612 and is provided between a driven element 564 andthe third spiral worm gear 652. The third spiral worm gear 652 is meshedto the fourth spiral worm gear 658, which may be coupled to the shaftassembly 538 and/or to another component of the instrument 522 for whichlongitudinal rotation is desired. Rotation may be caused in a CW and aCCW direction based on the rotational direction of the spiral worm gears656, 658. Accordingly, rotation of the third spiral worm gear 656 abouta first axis is converted to rotation of the fourth spiral worm gear 658about a second axis, which is orthogonal to the first axis. As shown inFIGS. 26 and 27, for example, the fourth spiral worm gear 658 is coupledto the shaft 538, and a CW rotation of the fourth spiral worm gear 658results in a CW rotation of the shaft assembly 538 in the directionindicated by 634CW. A CCW rotation of the fourth spiral worm gear 658results in a CCW rotation of the shaft assembly 538 in the directionindicated by 634CCW. Additional bearings may be provided between therotatable bodies and the corresponding gears. Any suitable bearings maybe provided to support and stabilize the mounting and reduce rotaryfriction of shaft and gears, for example.

Referring now to the alternate example mechanism for generatingreciprocating translation of one or more members along the axis of theshaft 538, the instrument mounting portion 558 comprises a rack andpinion gearing mechanism to provide reciprocating translation along theaxis of the shaft 538 (e.g., translation of a tissue cutting element 555of the RF surgical device 523). In one example embodiment, a thirdpinion gear 660 is coupled to a rotatable body 612 such that rotation ofthe corresponding driven element 564 causes the third pinion gear 660 torotate in a first direction. The third pinion gear 660 is meshed to arack gear 662, which moves in a linear direction. The rack gear 662 iscoupled to a translating block 664. The translating block 664 may becoupled to a component of the device 522, 523, such as, for example, thetissue cutting element 555 of the RF surgical device and/or an overtubeor other component which is desired to be translated longitudinally.

FIGS. 28-32 illustrate an alternate embodiment of the instrumentmounting portion 558 showing another alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538. In FIGS. 28-32, the shaft 538 iscoupled to the remainder of the mounting portion 558 via a coupler 676and a bushing 678. A first gear 666 coupled to a rotatable body 612, afixed post 668 comprising first and second openings 672, first andsecond rotatable pins 674 coupled to the shaft assembly, and a cable 670(or rope). The cable is wrapped around the rotatable body 612. One endof the cable 670 is located through a top opening 672 of the fixed post668 and fixedly coupled to a top rotatable pin 674. Another end of thecable 670 is located through a bottom opening 672 of the fixed post 668and fixedly coupled to a bottom rotating pin 674. Such an arrangement isprovided for various reasons including maintaining compatibility withexisting robotic systems 500 and/or where space may be limited.Accordingly, rotation of the rotatable body 612 causes the rotationabout the shaft assembly 538 in a CW and a CCW direction based on therotational direction of the rotatable body 612 (e.g., rotation of theshaft 538 itself). Accordingly, rotation of the rotatable body 612 abouta first axis is converted to rotation of the shaft assembly 538 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.28-29, for example, a CW rotation of the rotatable body 612 results in aCW rotation of the shaft assembly 538 in the direction indicated by634CW. A CCW rotation of the rotatable body 612 results in a CCWrotation of the shaft assembly 538 in the direction indicated by 634CCW.Additional bearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

FIGS. 33-36A illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fordifferential translation of members along the axis of the shaft 538(e.g., for articulation). For example, as illustrated in FIGS. 33-36A,the instrument mounting portion 558 comprises a double cam mechanism 680to provide the shaft articulation functionality. In one exampleembodiment, the double cam mechanism 680 comprises first and second camportions 680A, 680B. First and second follower arms 682, 684 arepivotally coupled to corresponding pivot spools 686. As the rotatablebody 612 coupled to the double cam mechanism 680 rotates, the first camportion 680A acts on the first follower arm 682 and the second camportion 680B acts on the second follower arm 684. As the cam mechanism680 rotates the follower arms 682, 684 pivot about the pivot spools 686.The first follower arm 682 may be attached to a first member that is tobe differentially translated (e.g., the first articulation band 622).The second follower arm 684 is attached to a second member that is to bedifferentially translated (e.g., the second articulation band 624). Asthe top cam portion 680A acts on the first follower arm 682, the firstand second members are differentially translated. In the exampleembodiment where the first and second members are the respectivearticulation bands 622 and 624, the shaft assembly 538 articulates in aleft direction 620L. As the bottom cam portion 680B acts of the secondfollower arm 684, the shaft assembly 538 articulates in a rightdirection 620R. In some example embodiments, two separate bushings 688,690 are mounted beneath the respective first and second follower arms682, 684 to allow the rotation of the shaft without affecting thearticulating positions of the first and second follower arms 682, 684.For articulation motion, these bushings reciprocate with the first andsecond follower arms 682, 684 without affecting the rotary position ofthe jaw 902. FIG. 36A shows the bushings 688, 690 and the dual camassembly 680, including the first and second cam portions 680B, 680B,with the first and second follower arms 682, 684 removed to provide amore detailed and clearer view.

In various embodiments, the instrument mounting portion 558 mayadditionally comprise internal energy sources for driving electronicsand provided desired ultrasonic and/or RF frequency signals to surgicaltools. FIGS. 36B-36C illustrate one embodiment of a tool mountingportion 558′ comprising internal power and energy sources. For example,surgical instruments (e.g., instrument 522) mounted utilizing the toolmounting portion 558′ need not be wired to an external generator orother power source. Instead, the functionality of the generator 20described herein may be implemented on board the mounting portion 558.

As illustrated in FIGS. 36B-36C, the instrument mounting portion 558′may comprise a distal portion 702. The distal portion 702 may comprisevarious mechanisms for coupling rotation of drive elements 592 to endeffectors of the various surgical instruments 522, for example, asdescribed herein above. Proximal of the distal portion 702, theinstrument mounting portion 558′ comprises an internal direct current(DC) energy source and an internal drive and control circuit 704. In theillustrated embodiment, the energy source comprises a first and secondbattery 706, 708. In other respects, the tool mounting portion 558′ issimilar to the various embodiments of the tool mounting portion 558described herein above. The control circuit 704 may operate in a mannersimilar to that described above with respect to generator 20. Forexample, the control circuit 704 may provide an ultrasonic and/orelectrosurgical drive signal in a manner similar to that described abovewith respect to generator 20.

FIGS. 37-38 illustrates one embodiment of a distal portion 1000 of asurgical instrument comprising a distally positioned jaw assembly 1003.The distal portion 1000 also comprises an ultrasonic blade 1014 and ashaft 1004 extending along a longitudinal axis 1002. A clevis 1006coupled to a distal portion of the shaft 1004 pivotably receives the jawassembly 1003. For example, a wrist member 1008 of the jaw assembly 1003may be pivotably coupled to the clevis 1006 about a first axis or wristpivot axis 1018. Pivoting of the jaw assembly 1003 about the wrist pivotaxis 1018 may cause the jaw assembly 1003 to pivot in the directionsindicated by arrow 1022. The wrist member 1008 may be coupled to theclevis 1006 utilizing any suitable pivotable connector or connectorassembly. For example, in some embodiments, the wrist member 1008 may becoupled to clevis 1006 with a pin 1011 that may ride within a hole 1013defined by the clevis 1006.

First and second jaw members 1010, 1012 may be pivotably coupled to thewrist member 1008 and configured to pivot about a second axis, or jawpivot axis 1016. Pivoting of the jaw members 1010, 1012 about the jawpivot axis 1016 may cause the respective jaw members 1010, 1012 to pivotin the directions indicated by arrow 1020. The jaw members 1010, 1012may be pivotable about the jaw pivot axis 1016 relative to one anotherand absolutely. For example, the jaw members 1010, 1012 may pivotrelative to one another from open positions, where the jaw members 1010,1012 are separated from one another as shown in FIG. 37, to a closedposition where the jaw members 1010, 1012 are substantially parallel toone another (and optionally in contact with one another). For example,tissue may be grasped between the jaw members 1010, 1012 when they areat or near the closed position. In some embodiments, one or both of thejaw members 1010, 1012 is also absolutely pivotably about the jaw pivotaxis 1016. This may allow the general orientation of the jaw assembly1003 to pivot about the axis 1016 (from left to right in the orientationillustrated in FIG. 37).

FIG. 39 illustrates a head-on view of one embodiment of the distalportion 1000 of the surgical instrument of FIGS. 37-38. In FIG. 39,various control pulleys 1026, 1028, 1030, 1032 are illustrated, alongwith openings 1031, 1032 in the clevis 1006 for control lines to passthrough. Additional details of the various control lines and controlpulleys are provided herein below. FIG. 39 also illustrates additionaldetails of the jaw members 1010, 1012. In the embodiment shown in FIG.39, for example, the jaw members 1010, 1012 define teeth 1024. In someembodiments, the teeth 1024 interlock when the jaw members 1010, 1012are in a closed position relative to one another. In other embodiments,however, the teeth 1024 do not interlock when the jaw members 1010, 1012are in a closed position relative to one another.

FIGS. 40-41 illustrate one embodiment of the distal portion 1000 of thesurgical instrument of FIGS. 37-38 coupled to an instrument mountingportion 1034 for use with a robotic surgical system, such as the system500 described herein above. The shaft 1004 may be coupled to theinstrument mounting portion 1034. The instrument mounting portion 1034may contain various mechanisms and interfaces for actuating theultrasonic blade 1014, articulating the jaw assembly 1003 and, in someembodiments, retracting and extending the ultrasonic blade 1014, forexample, as described herein below.

FIGS. 42-44 illustrate one embodiment of the distal portion 1000 of thesurgical instrument of FIGS. 37-38 showing additional controlmechanisms. Each of the jaw members 1010, 1012 may comprise respectivepulleys 1041, 1043 centered on the jaw pivot axis 1016. Rotation of thepulleys 1041, 1043 may cause corresponding pivoting of the respectivejaw members 1010, 1012. Rotation of the pulleys 1041, 1043 (andcorresponding pivoting of the jaw members 1010, 1012) may be broughtabout utilizing control lines 1038, 1040, 1048, 1050. For example,control line 1040 may be coupled to and/or wrapped around pulley 1043such that proximal translation of the control line 1040 causes the jawmember 1012 to pivot about the jaw pivot axis 1016 towards the controlline 1040 (e.g., out of the page from the perspective shown in FIGS.42-43). Pivoting of the jaw member 1012 in the opposition direction(e.g., into the page from the perspective shown in FIGS. 42-43) may beactuated utilizing a control line 1048 also coupled to and/or wrappedaround the pulley 1043. Proximal translation of the control line 1048may cause the jaw member 1012 to pivot towards the control line 1048.When the control line 1048 is coupled to the pulley 1043, it may becoupled at a position substantially opposite the position where thecontrol line 1040 is coupled to the pulley 1043. Also, in someembodiments, control lines 1048, 1040 may be opposite ends of a singlecable wrapped around the pulley 1043.

Similarly, control line 1038 may be coupled to and/or wrapped aroundpulley 1041 such that proximal translation of the control line 1038causes the jaw member 1010 to pivot about the jaw pivot axis 1016towards the control line 1038 (e.g., again out of the page from theperspective shown in FIGS. 42-43). Control line 1050 may also be coupledto and/or wrapped around pulley 1041 such that proximal translation ofthe control line 1050 causes the jaw member 1010 to pivot about the jawpivot axis towards the control line 1050 (e.g., into the page from theperspective shown in FIGS. 42-43). Control lines 1038, 1050 may beseparately coupled to the pulley 1041 or, in some embodiments, mayrepresent separate ends of a single cable or other line wrapped aroundthe pulley 1041. It will be appreciated that as the jaw assembly 1003pivots about the wrist pivot axis 1018, the orientation of the controllines 1038, 1040, 1048, 1050 relative to the pulleys 1041, 1043 maychange.

To prevent the control lines from becoming strained and/or disengagedwith the pulleys 1041, 1043, various idler pulleys 1026, 1028, 1036,1042, 1046, 1044, 1030, 1032 (FIG. 39) may be included to route thecontrol lines 1038, 1040, 1048, 1050 to the shaft 1004. Also, in someembodiments, the control lines are routed to the shaft 1004 via holes inthe clevis 1006. FIG. 39 illustrates example holes 1031, 1032 that maybe utilized by cables 1048, 1050, respectively.

Pivoting of the wrist member 1008 (and thereby the jaw assembly 1003)may also be actuated utilizing control lines. For example, referring toFIGS. 42 and 44, a control line 1052 is visible coupled to the wristmember 1008 at a position offset from the wrist pivot axis 1018.Proximal translation of the control line 1052 may pull the jaw assembly1003 away from the ultrasonic blade 1014, for example, up from theperspective shown in FIG. 42 and out of the page from the perspectiveshown in FIG. 44. A similar control line 1053 may be coupled to a lowerportion of the wrist member 1008 such that proximal translation of thecontrol line 1053 causes the jaw assembly 1003 to pivot towards theultrasonic blade 1014 (e.g., down from the perspective shown in FIG. 42and into the page from the perspective shown in FIG. 44). The controllines 1052, 1053, in some embodiments, may be ends of a single cable orcontrol line wrapped through and coupled to the wrist member 1008. Also,in some embodiments, the control line 1053 may be omitted. Pivoting ofthe jaw assembly 1003 towards the ultrasonic blade 1014 may be broughtabout by distal translation of the control member 1052.

The various control lines 1038, 1040, 1048, 1050, 1052, 1053 may extendproximally through the shaft 1004 where they may be actuated at a handleor an instrument mounting portion of a robotic surgical system, such asthe instrument mounting portion 1034 described herein. As describedabove, differential translation of control line pairs (1038/1050,1040/1048, 1052, 1053) may cause articulation of the various componentsof the jaw assembly 1003. Differential translation of control lines maybe brought about in any suitable manual and/or automated manner, forexample, as described above.

FIG. 45A illustrates one embodiment of the instrument mounting portion1034 showing an example mechanism for actuating various control lines ofthe surgical instrument of FIGS. 37-38. The various control lines 1038,1040, 1048, 1050, 1052, 1053 may extend proximally through the shaft1004 and enter the instrument mounting portion 1034. The various controllines may be routed by routers 1056 to various spools 1039, 1041, 1043mounted on the rotatable bodies described above. FIG. 45B illustrates aside view of one embodiment of the routers 1056. For example, the router1056 shown in FIG. 45B comprises a plurality of grooves 1058 forreceiving and routing the various control lines. More or fewer groovesmay be included in routers 1056, for example, based on the number ofcontrol lines that they are configured to route.

Referring back to FIG. 45A, in some embodiments, control lines 1038 and1050 may be routed to spool 1039. According to the picturedconfiguration, clockwise rotation of the spool 1039 causes proximaltranslation of the control line 1038 and distal translation of thecontrol line 1050. This, as described above, may cause the jaw member1010 to pivot about the jaw pivot axis 1016 to the left from theperspective of FIG. 44 and out of the page from the perspective of FIGS.42-43. Counterclockwise rotation of the spool 1039 causes distaltranslation of the control line 1038 and proximal translation of thecontrol line 1050. This, again as described above, may cause the jawmember 1010 to pivot about the jaw pivot axis 1016 to the right from theperspective of FIG. 44 and into the page from the perspective of FIGS.42-43. Control lines 1040 and 1048 may be routed to spool 1040.Clockwise and counterclockwise rotation of the spool 1041 maydifferentially translate control lines 1040 and 1048, causing the jawmember 1012 to pivot about the jaw pivot axis 1016 similar to the jawmember 1010 described above. The control lines 1052 and 1053 may besimilarly coupled to spool 1043 to control pivoting of the jaw assembly1003 about the wrist pivot axis 1016 upon clockwise and counterclockwiserotation of the spool 1043.

According to various embodiments, the surgical instrument of FIGS. 37-38may be implemented with a retractable ultrasonic blade 1014. Forexample, the ultrasonic blade 1014 may be retractable in a proximaldirection such that it is partially or completely within the shaft 1004and/or clevis 1006. This may increase the range of motion of the jawassembly 1003 about the wrist pivot axis 1018. FIGS. 46-47 illustrateone embodiment of the distal portion 1000 of the surgical instrument ofFIGS. 37-38 with a retractable ultrasonic blade 1014. Referring now toFIG. 46, the blade 1014 is shown retracted in the proximal directionindicated by arrow 1060 within the shaft 1004. As can be seen, thisincreases the range of motion of the jaw assembly 1003 to pivot aboutthe wrist pivot axis 1018. For example, as illustrated in FIG. 46, thejaw assembly 1003 may pivot to and past a location where it would haveotherwise contacted the ultrasonic blade 1014. This may increase therange in which the jaw assembly 1003 is able to grasp tissue. In use,the jaw assembly 1003 may grasp tissue while pivoted to the positionshown in FIG. 46. The jaw assembly 1003 may then be pivoted back toand/or beyond the position shown in FIG. 47 so that the blade 1014 maybe extended distally to act on the grasped tissue.

The ultrasonic blade 1014 may be coupled to an ultrasonic waveguide 1058that may extend proximally through the shaft 1004 to an ultrasonictransducer, such as the transducer 16 described above. In someembodiments, translation of the ultrasonic blade 1014 may be broughtabout by translation of the blade 1014, waveguide 1058 and transducerassembly. FIG. 48 illustrates one embodiment of the distal portion 1000of the surgical instrument of FIGS. 37-38 coupled to an instrumentmounting portion 1034 of a robotic surgical system configured to extendand retract the ultrasonic blade 1014. As illustrated, the waveguide1058 extends proximally from the ultrasonic blade 1014 through the shaft1004 to the instrument mounting portion where it is coupled to anultrasonic transducer assembly 1064 located within the instrumentmounting portion 1034. A rack gear 1062 is coupled to the waveguide 1058and may be positioned to be engaged by a round gear coupled to one ofthe rotating bodies 612 of the instrument mounting portion 1034. Forexample, FIG. 45 illustrates the rack gear 1062 coupled to a gear 1047,which is, in turn, coupled to a gear 1045 that rotates with the rotatingbody 612. Alternate rotation of the rotating body 612 may cause rotationof the respective gears 1045, 1047 that may, in turn, cause distal andproximal translation of the rack gear 1062. As the rack gear 1062 iscoupled to the waveguide 1058, distal and proximal translation of therack gear 1062 may also cause distal and proximal translation of thewaveguide 1058, blade 1014 and transducer 1064.

In the embodiment illustrated in FIG. 48, the transducer 1064 ispositioned within the instrument mounting portion 1034. Aflexible/extendible cable 1066 may be coupled the transducer 1064 andultimately to an external cable 1067. As the transducer translatesdistally and proximally with the waveguide 1058 and blade 1014, thecable 1066 may alternately slacken and tighten so as to maintain itsconnection to the external cable 1067. FIG. 49 illustrates an alternateembodiment of the distal portion 1000 of the surgical instrument ofFIGS. 37-38 coupled to an instrument mounting portion of a roboticsurgical system with an external transducer 1070. As illustrated, thetransducer extends beyond the instrument mounting portion 1034. FIG. 49also illustrates the track gear 1062 coupled to the waveguide 1058 thatmay act (in conjunction with one of the rotatable members 612) totranslate the waveguide 1058, blade 1014 (not shown in FIG. 49) andtransducer 1070 proximally and distally. FIG. 50 illustrates anadditional view of the distal portion 1000 of the surgical instrument ofFIGS. 37-38 as illustrated in FIG. 49.

FIG. 51 illustrates one embodiment of the jaw assembly 1003 comprising aclamp pad 1072. The clamp pad 1072 may comprise one or more componentscoupled to at least one face of the wrist member 1008 and/or one of thejaw members 1010, 1012. For example, FIG. 51 illustrates a face 1074 ofthe wrist member 1008 directed towards the ultrasonic blade 1014 and aface 1076 of the jaw member 1012 directed towards the ultrasonic blade1014. One or more of these faces may be coupled to a clamp pad 1072. Theclamp pad 1072 may be similar to the clamp arm assembly 64 describedherein. For example, the clamp pad 1072 may be configured to be inphysical contact with the ultrasonic blade 1014 without substantiallyaffecting the operation of the blade 1014. In the way, a clinician mayutilize the jaw assembly 1003 to clamp tissue to the blade 1014 in amanner similar to that described above with respect to clamp armassembly 64.

FIGS. 52-55 illustrate one embodiment of a distal portion 1101 of asurgical instrument comprising a jaw assembly 1100. The distal portion1101 may additionally comprise a shaft portion 1110, a clevis 1112 andan ultrasonic blade 1106. As described herein above, the ultrasonicblade 1106 may be in mechanical communication with an ultrasonicwaveguide (not shown in FIG. 52) that may extend proximally to atransducer, such as the transducer 16 of FIG. 1. In some embodiments,the ultrasonic bladed 1106 may be retractable, as described hereinabove.

The jaw assembly 1100 may comprise a jaw member 1102 and an opposableU-shaped jaw member 1104. The jaw members 1102, 1104 may be pivotablycoupled to the clevis 1112 that may be, in turn, coupled to a shaft1110. The jaw members 1102, 1104 may be separately pivotable about anaxis 1109 in a manner similar to that described above by which the jawmembers 1010, 1012 are separately pivotable about the axis 1016. Forexample, the jaw members 1102, 1104 may be separately pivoted about theaxis 1109 to an open position where the jaw members 1102, 1104 arepivoted away from one another. The jaw members 1102, 1104 may also beseparately pivoted about the axis 1109 to a closed position where thejaw members 1102, 1104 are near and/or in contact with one another, forexample, as shown in FIGS. 53 and 55. In various embodiments the jawmembers 1102, 1104 may be at either an open or closed position atvarious angles relative to a longitudinal axis 1002 of the shaft. Forexample, FIG. 52 shows the jaw members 1102, 1104 in an open positionpivoted away from the longitudinal axis 1002. FIG. 53 shows the jawmembers 1102, 1104 in a closed position substantially parallel to theultrasonic blade 1106. The axis 1109 may be substantially perpendicularto the longitudinal axis 1002.

In various embodiments, the jaw members 1102, 1104 may be utilized tocapture tissue and maneuver the captured tissue towards the ultrasonicblade 1106 for cutting and/or coagulation. For example, the U-shaped jawmember 1104 may comprise a pair of tines 1104 a, 1104 b. The tines 1104a, 1104 b may define an opening 1105 between the tines 1104 a, 1104 b.The jaw member 1102 and ultrasonic blade 1106 may be aligned with theopening. In this way, the jaw members 1102, 1104 may be pivoted to anopen position with at least the jaw member 1102 away from thelongitudinal axis 1002 to capture tissue, such as tissue 1114 shown inFIG. 55. In some embodiments, the jaw member 1102 may fit at least intothe opening 1105 between the tines 1104 a, 1104 b. Accordingly, the jawmember 1102 may push a portion of the tissue 1114 through the opening1105 where it may contact the ultrasonic blade 1106 for cutting and/orcoagulation, as shown in FIG. 55.

The jaw members 1102, 1104 may be controlled in any suitable manner. Forexample, referring to FIG. 56, a pulley 1116 may be positioned about theaxis 1109 and coupled to the jaw member 1104. A similar pulley 1118 maybe positioned about the axis 1109 and coupled to the jaw member 1102.Cables 1120, 1122 may be coupled around the respective pulleys 1116,1118 in a manner similar to that described herein above with respect topulleys 1041, 1043 and cables 1038, 1040. Differential movement of thecable 1120 may cause the jaw member 1104 to pivot about the axis 1109,as described above. Similarly, differential movement of the cable 1122may cause the jaw member 1102 to pivot about the axis 1109 also asdescribed above. Referring now to FIG. 54, the shaft 1110 may define acavity 1115. The respective cables 1120, 1122 may extend proximally fromthe jaw assembly 1100 through the cavity 1115. The cables 1120, 1122 maybe controlled in any suitable manner. For example, the cables may becontrolled by an instrument mounting portion, similar to the instrumentmounting portion shown in FIG. 45 and/or by a hand-held controller, suchas the handle 12 described herein above.

Non-Limiting Embodiments

Various embodiments are directed to surgical instruments comprising anend effector, a shaft and a jaw assembly. The end effector may comprisean ultrasonic blade extending distally substantially parallel to alongitudinal axis. The shaft may extend proximally from the end effectoralong the longitudinal axis. The jaw assembly may comprise first andsecond jaw members. The jaw assembly may be pivotable about a first axissubstantially perpendicular to the longitudinal axis from a firstposition where the first and second jaw members are substantiallyparallel to the ultrasonic blade to a second position. Additionally, thefirst and second jaw members may be pivotable about a second axissubstantially perpendicular to the first axis.

In some embodiments, the jaw assembly comprises a wrist member, a firstjaw member and a second jaw member. The wrist member may be pivotableabout a wrist pivot axis substantially perpendicular to the longitudinalaxis from a first position where the wrist member is substantiallyparallel to the ultrasonic blade to a second position where the wristmember is pivoted away from the ultrasonic blade. The first jaw membermay extend distally from and be pivotably coupled to the wrist member.The first jaw member may also be pivotable about a jaw pivot axissubstantially perpendicular to the wrist pivot axis. The second jawmember may extend distally from and also be pivotably coupled to thewrist member. The second jaw member may also be pivotable about the jawpivot axis. The first and second jaw members may be further pivotableabout the jaw pivot axis relative to one another from an open positionwhere the first and second jaw members are pivoted away from one anotherto a closed position where the first and second jaw members are pivotedtowards one another.

Applicant also owns the following patent applications that are eachincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 13/536,271, filed on Jun. 28, 2012 andentitled FLEXIBLE DRIVE MEMBER, now U.S. Pat. No. 9,204,879;

U.S. patent application Ser. No. 13/536,288, filed on Jun. 28, 2012 andentitled MULTI-FUNCTIONAL POWERED SURGICAL DEVICE WITH EXTERNALDISSECTION FEATURES, now U.S. Patent Application Publication No.2014/0005718;

U.S. patent application Ser. No. 13/536,295, filed on Jun. 28, 2012 andentitled ROTARY ACTUATABLE CLOSURE ARRANGEMENT FOR SURGICAL ENDEFFECTOR, now U.S. Pat. No. 9,119,657;

U.S. patent application Ser. No. 13/536,326, filed on Jun. 28, 2012 andentitled SURGICAL END EFFECTORS HAVING ANGLED TISSUE-CONTACTINGSURFACES, now U.S. Pat. No. 9,289,256;

U.S. patent application Ser. No. 13/536,303, filed on Jun. 28, 2012 andentitled INTERCHANGEABLE END EFFECTOR COUPLING ARRANGEMENT, now U.S.Pat. No. 9,028,494;

U.S. patent application Ser. No. 13/536,393, filed on Jun. 28, 2012 andentitled SURGICAL END EFFECTOR JAW AND ELECTRODE CONFIGURATIONS, nowU.S. Patent Application Publication No. 2014/0005640;

U.S. patent application Ser. No. 13/536,362, filed on Jun. 28, 2012 andentitled MULTI-AXIS ARTICULATING AND ROTATING SURGICAL TOOLS, now U.S.Pat. No. 9,125,662; and

U.S. patent application Ser. No. 13/536,417, filed on Jun. 28, 2012 andentitled ELECTRODE CONNECTIONS FOR ROTARY DRIVEN SURGICAL TOOLS, nowU.S. Pat. No. 9,101,385.

It will be appreciated that the terms “proximal” and “distal” are usedthroughout the specification with reference to a clinician manipulatingone end of an instrument used to treat a patient. The term “proximal”refers to the portion of the instrument closest to the clinician and theterm “distal” refers to the portion located furthest from the clinician.It will further be appreciated that for conciseness and clarity, spatialterms such as “vertical,” “horizontal,” “up,” or “down” may be usedherein with respect to the illustrated embodiments. However, surgicalinstruments may be used in many orientations and positions, and theseterms are not intended to be limiting or absolute.

Various embodiments of surgical instruments and robotic surgical systemsare described herein. It will be understood by those skilled in the artthat the various embodiments described herein may be used with thedescribed surgical instruments and robotic surgical systems. Thedescriptions are provided for example only, and those skilled in the artwill understand that the disclosed embodiments are not limited to onlythe devices disclosed herein, but may be used with any compatiblesurgical instrument or robotic surgical system.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one example embodiment,” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment is included in at least one example embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one example embodiment,” or “in an embodiment” inplaces throughout the specification are not necessarily all referring tothe same embodiment. Furthermore, the particular features, structures,or characteristics illustrated or described in connection with oneexample embodiment may be combined, in whole or in part, with features,structures, or characteristics of one or more other embodiments withoutlimitation.

While various embodiments herein have been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. For example, each of thedisclosed embodiments may be employed in endoscopic procedures,laparoscopic procedures, as well as open procedures, without limitationsto its intended use.

It is to be understood that at least some of the figures anddescriptions herein have been simplified to illustrate elements that arerelevant for a clear understanding of the disclosure, while eliminating,for purposes of clarity, other elements. Those of ordinary skill in theart will recognize, however, that these and other elements may bedesirable. However, because such elements are well known in the art, andbecause they do not facilitate a better understanding of the disclosure,a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent,however, that various modifications, alterations and adaptations tothose embodiments may occur to persons skilled in the art with theattainment of some or all of the advantages of the disclosure. Forexample, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Thisapplication is therefore intended to cover all such modifications,alterations and adaptations without departing from the scope and spiritof the disclosure as defined by the appended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical instrument, comprising: a shaftassembly extending along a longitudinal axis; an ultrasonic waveguideextending along the longitudinal axis; and an end effector extendingfrom the shaft assembly, wherein the end effector comprises: anultrasonic blade extending from the ultrasonic waveguide, wherein theultrasonic blade is configured to move relative to the longitudinal axisbased on ultrasonic vibrations applied to the ultrasonic waveguide by anultrasonic transducer; and a jaw assembly, comprising: a first jawpivotable relative to the ultrasonic blade about a pivot axis; and asecond jaw pivotable relative to the ultrasonic blade about the pivotaxis, wherein the first jaw and the second jaw are pivotable relative toeach other between an open configuration and a closed configuration,wherein the second jaw comprises a first tine and a second tine, andwherein the first tine and the second tine define a gap therebetween,wherein the first jaw can fit into the gap.
 2. The surgical instrumentof claim 1, wherein the ultrasonic blade and the first jaw are alignedwith the gap.
 3. The surgical instrument of claim 2, wherein the firstjaw is configured to push tissue through the gap into contact with theultrasonic blade.
 4. The surgical instrument of claim 1, wherein thefirst jaw and the second jaw are movable in the closed configurationbetween a plurality of angles relative to the ultrasonic blade.
 5. Thesurgical instrument of claim 1, further comprising: a first pulleysystem comprising a first cable, wherein the first pulley system isconfigured to pivot the first jaw relative to the ultrasonic blade; anda second pulley system comprising a second cable, wherein the secondpulley system is configured to pivot the second jaw relative to theultrasonic blade.
 6. The surgical instrument of claim 5, wherein theshaft assembly comprises a cavity, and wherein the first cable and thesecond cable extend through the cavity.
 7. The surgical instrument ofclaim 1, wherein the ultrasonic blade is moveable relative to the jawassembly between an extended position and a retracted position.
 8. Asurgical system, comprising: an ultrasonic transducer configured toproduce ultrasonic vibrations; an elongate shaft; an ultrasonicwaveguide extending from the ultrasonic transducer along a longitudinalaxis; and an end effector, comprising: an ultrasonic blade extendingfrom the ultrasonic waveguide, wherein the ultrasonic blade isconfigured to move relative to the longitudinal axis based on ultrasonicvibrations produced by the ultrasonic transducer; and a jaw assembly,comprising: a first jaw pivotable relative to the ultrasonic blade abouta pivot axis; and a second jaw pivotable relative to the ultrasonicblade about the pivot axis, wherein the first jaw and the second jaw arepivotable relative to each other between an open configuration and aclosed configuration, and wherein the second jaw comprises a first prongand a second prong, wherein the first prong and the second prong definea gap therebetween, and wherein the first jaw is movable into the gap.9. The surgical system of claim 8, wherein the ultrasonic blade and thefirst jaw are aligned with the gap.
 10. The surgical system of claim 9,wherein the first jaw is configured to push tissue through the gap intocontact with the ultrasonic blade.
 11. The surgical system of claim 8,wherein the first jaw and the second jaw are movable in the closedconfiguration between a plurality of angles relative to the ultrasonicblade.
 12. The surgical system of claim 8, further comprising: a firstcable operably coupled to the first jaw, wherein the first cable isconfigured to pivot the first jaw relative to the ultrasonic blade; anda second cable operably coupled to the second jaw, wherein the secondcable is configured to pivot the second jaw relative to the ultrasonicblade.
 13. The surgical system of claim 12, wherein the elongate shaftcomprises a cavity, and wherein the first cable and the second cableextend through the cavity.
 14. The surgical system of claim 8, whereinthe ultrasonic blade is moveable relative to the jaw assembly between anextended position and a retracted position.
 15. A surgical end effector,comprising: an ultrasonic blade configured to move relative to alongitudinal axis based on ultrasonic vibrations produced by anultrasonic transducer; and a jaw assembly, comprising: a first jawpivotable relative to the ultrasonic blade about a pivot axis; and asecond jaw pivotable relative to the ultrasonic blade about the pivotaxis, wherein the first jaw and the second jaw are pivotable relative toeach other between an open configuration and a closed configuration,wherein the second jaw comprises a first branch and a second branch,wherein the first branch and the second branch define a gaptherebetween, and wherein the first jaw is movable into the gap.
 16. Thesurgical end effector of claim 15, wherein the ultrasonic blade and thefirst jaw are aligned with the gap.
 17. The surgical end effector ofclaim 16, wherein the first jaw is configured to push tissue through thegap into contact with the ultrasonic blade.
 18. The surgical endeffector of claim 15, wherein the first jaw and the second jaw aremovable in the closed configuration between a plurality of anglesrelative to the ultrasonic blade.
 19. The surgical end effector of claim15, wherein the first jaw and the second jaw are separately pivotableabout the pivot axis by a cable-driven system.
 20. The surgical endeffector of claim 15, wherein the ultrasonic blade is moveable relativeto the jaw assembly between an extended position and a retractedposition.